Modern Healthcare

A recent federal court ruling could shake up the Medicare Advantage Star Ratings program.

The decision only requires the Centers for Medicare and Medicaid Services to recalculate 2026 Medicare Advantage star ratings for Clover Health, but its consequences could reach further and lead to higher quality scores, and more bonus revenue, across the industry.

That’s because the U.S. District Court for the Southern District of Georgia concluded last week that 20 of the roughly 40 metrics CMS tracks to evaluate quality were improperly created or implemented. The agency uses those measures for all Medicare Advantage carriers, meaning any company dissatisfied with its scores could make the same arguments in court.

Clover Health’s win could upend Medicare Advantage star ratings

Ascension’s push to expand its outpatient network has taken a big step forward with its $3.9 billion acquisition of sprawling ambulatory surgery center operator Amsurg.

The nonprofit health system vaults to become the third-largest surgery center operator by adding roughly 250 centers to its footprint. On its own, Ascension operated only 58 locations. United Surgical Partners International, a subsidiary of Tenet Healthcare Corp., and UnitedHealth Group’s Optum subsidiary SCA Health are the largest operators by number of surgery center locations.

Here are strategic and leadership changes that paved the way for the Ascension-Amsurg deal and its growth plans.

Ascension spent years building to its Amsurg buy. Here’s how

The Health and Human Services Department is pressuring states to ramp up anti-fraud enforcement.

HHS decertifies Hawaii Medicaid Fraud Unit

Lifepoint Health acquired eight hospitals from ScionHealth following a March definitive agreement.

Lifepoint completes ScionHealth deal, expands to 68 hospitals