CMS recalculates Medicare Advantage stars after Clover lawsuit loss

Regulation
โดย Healthcare Dive·Read original
Summary · why it matters

The Centers for Medicare and Medicaid Services is recalculating 2026 Medicare Advantage star ratings for insurers after losing a court case over its methodology, but only plans that see their scores increase will have ratings updated and be allowed to resubmit bids. The recalculation stems from a lawsuit by Clover Health, whose largest plan dropped from 4 stars to 3.5 stars, costing the company about $120 million in bonus payments. A Georgia federal judge ordered CMS to recalculate Clover's rating without 20 disputed measures, and the agency has now voluntarily extended the recalculation to other plans, though it is removing only measures the judge ruled CMS lacked authority to collect, along with some additional unchallenged measures. TD Cowen analysts estimate that if the Clover criteria were applied broadly, UnitedHealthcare's average scores would rise from 4.11 to 4.27, a $500 million benefit, and Elevance's would move from 3.9 to 3.92, a $25 million benefit, but the current approach yields little change for most insurers. CMS noted the recalculation does not affect its right to appeal the ruling, and the move could prompt further lawsuits from insurers unhappy with their ratings.

Impact on stocks 3

Aging Population · 2 stocks
Clover Health Investments Corp
CLOV
▲ PositiveRegulationrelevance

Clover Health won lawsuit forcing CMS to recalculate star ratings, potentially restoring $120M in bonus payments.

UnitedHealth Group Incorporated
UNH
± MixedRegulationrelevance

UnitedHealthcare could gain $500M if broad criteria applied, but current recalculation limited; uncertainty remains.

Health Care · 1 stocks
Elevance Health Inc
ELV
± MixedRegulationrelevance

Elevance may see slight benefit ($25M) if criteria applied broadly, but current approach yields little change.

Theme Impact 1

Related news

CVS Omnicare Wins Court Approval for Chapter 11 Liquidation

A Texas bankruptcy judge has approved a wind-down Chapter 11 plan for CVS Omnicare, the long-term care pharmacy subsidiary of CVS Health, after the company sold its business operations for $250 million and reached a $440 million settlement with the Justice Department over an improper billing case. Judge Stacey G. C. Jernigan of the U.S. Bankruptcy Court for the Northern District of Texas approved the plan, noting it received overwhelming acceptance from general unsecured creditors. Omnicare, which CVS has owned since 2015 and which serves nursing homes, assisted living centers, and long-term care and rehab facilities, filed for bankruptcy in September 2025, months after a $949 million judgment for fraudulently dispensing drugs without valid prescriptions to elderly and disabled patients. The government resolved that judgment through the $440 million settlement, which requires CVS to pay $130 million upfront and cover the remaining $310 million if Omnicare fails to pay by March 2028. The purchaser, GenieRx Holdings, is a joint partnership between Milrose Capital LLC and Integro Asset Management LLC, and Omnicare attorney Martha Wyrick of Haynes and Boone LLP said the sale is expected to close next month.
TheStreet·23hRead more →

Healthpeak Raises 2026 Guidance on Portfolio Sales and Janus Living Growth

Healthpeak Properties raised its full-year 2026 guidance for the second time this year, now expecting diluted earnings per share of $0.48 to $0.52, up from $0.46 to $0.50, and diluted FFO as Adjusted of $1.73 to $1.77, two cents higher at the midpoint than its prior outlook. The healthcare real estate owner signed 1.6 million square feet of new and renewal leases in the quarter, lifting outpatient medical occupancy 20 basis points to 90.7% and lab occupancy 80 basis points to 78.5%. Growth was led by Janus Living, the senior housing operator Healthpeak controls with a 73.6% stake, where revenue jumped 45% year over year to $216 million and Adjusted EBITDA rose 34% to $79 million, with same-store margins expanding 250 basis points. Healthpeak funded buybacks and debt paydown largely by selling stakes in existing buildings, including July's recapitalization that sold a 49% stake in an 86-property outpatient medical portfolio to Brookfield for roughly $1.025 billion at a 5.9% cap rate, part of $1.4 billion of proceeds generated in the quarter and through August 3. Lab same-store net operating income fell 3.2%, the only one of Healthpeak's three core businesses to shrink, holding total company-wide same-store NOI growth to 1.8%.
Insider Monkey·1dRead more →

Aevis Victoria H1 2026 NAV Rises 7% as Healthcare Margins Improve

Aevis Victoria reported a net asset value of CHF26.75 per share for H1 2026, up nearly 7% year-over-year and 2.3% versus the prior year-end level, while the discount to NAV remained above 50%, which management described as unprecedented in the group's history. Within the healthcare segment, Swiss Medical Network's EBITDA margin improved from 18.6% to 21.6%, and ambulatory services turned EBITDA-positive for the first time, with its margin rising from 7.1% to 11.8%. The company set a healthcare EBITDA margin target of 23% with organic growth of 2% to 3% per year, noting mature hospitals representing over 50% of the portfolio can reach more than 25% to 26% EBITDA margin while ramp-up hospitals sit at 10% to 20%. Interest expenses declined 43% year-over-year, consolidated net debt stood at CHF846 million with the bulk under Swiss Hotel Property, Swiss Medical Network's net debt-to-EBITDA was approximately 2.2x to 2.3x, and loan-to-value for the real estate business fell to 45%. Chief Financial Officer Michel Keusch cited three catalysts to narrow the discount to NAV: a next phase of value crystallization through selling stakes to strategic shareholders, including the officially announced search for strategic investors in Swiss Medical Network; enhanced investor relations with more roadshows, a Capital Markets Day and greater financial transparency; and a near-quintupling of average daily liquidity over the past two years.
GuruFocus·1dRead more →