SCAN Health Plan Prevails in 2024 Star Ratings Lawsuit Against the Centers for Medicare and Medicaid Services

LONG BEACH, Calif.—June 6, 2024— SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage health plans, prevailed in a legal action (Doc# 33, D.D.C. 1:23-cv-03910-CJN) against the Centers for Medicare and Medicaid Services (CMS) that challenged CMS’s calculation of SCAN’s 2024 Star Rating, a quality assessment given by CMS that affects both its federal funding and how it is viewed by consumers. As a result of the United States District Court for the District of Columbia’s ruling on June 3, 2024, SCAN’s 2024 Star rating will be recalculated.

“We pursued this case with determination and vigor on behalf of our members and provider partners,” said Dr. Sachin Jain, CEO of SCAN Group and SCAN Health Plan. “Our Star Ratings have a significant impact on our ability to deliver on the rich benefits our members have come to rely on and to compensate our provider partners for the care they deliver.”

The Court’s ruling comes at a critical time in the managed care industry when recent risk model adjustments compress revenue streams, and Star Ratings and Part D program changes have put pressure on Medicare Advantage plans’ ability to maintain benefit consistency.

“Our victory means $250 million in revenue for SCAN—this significantly impacts what we can invest in benefits and provide proper payment to providers,” said Karen Schulte, President of Medicare, SCAN Health Plan. “We embarked on this journey because we are committed to our members and provider partners, and we are thrilled we did. Now, we can confidently say that we go to extreme lengths to ensure our members are cared for and covered.”

Every year, Medicare evaluates plans based on a 5-star rating system. The recalculation of SCAN’s 2024 Star Ratings in California is still pending.

About SCAN Health Plan 
SCAN Health Plan is one of the nation’s largest not-for-profit Medicare Advantage plans, serving more than 277,000 members across California, Arizona, Nevada, New Mexico and Texas. Since its founding in 1977, SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent. Independence at Home, a SCAN community service, provides vitally needed services and support to seniors and their caregivers regardless of plan membership. SCAN also offers educational programs, community funding, volunteer opportunities and other community services throughout our service areas. To learn more, visit scanhealthplan.com or follow us on Twitter @scanhealthplan.

Media Contact: 
Seffrah Orlando
sorlando@scanhealthplan.com
562-508-6781