July 9, 2026

Elevance Health is suing the Centers for Medicare & Medicaid Services, alleging the agency used a more favorable methodology to recalculate Clover Health's 2026 Medicare Advantage star ratings than it applied to other insurers, costing Elevance an estimated $115 million in bonus payments. The lawsuit highlights ongoing disputes over the Medicare Advantage star ratings program, which has faced increasing legal challenges and criticism over whether it accurately measures quality while contributing to higher government spending and insurer overpayments.

An independent audit commissioned by UnitedHealth Group found that 96.6% of diagnoses made during its HouseCalls in-home Medicare visits were supported by patients' medical records, with the remaining unsupported diagnoses largely backed by insurance claims data. The company says these findings support the integrity of the program, though critics and government investigators continue to question whether home health assessments in Medicare Advantage can lead to inflated diagnoses and higher federal reimbursements.

ARHOME covers Arkansans aged 19 to 64 with income up to 138% of the federal poverty level. The state uses Medicaid funding to buy those enrollees coverage in plans through the ACA exchanges. Centene’s exit is notable for signaling how Medicaid insurers are reconsidering their state footprints in advance of looming work requirements from the “One Big Beautiful Bill” passed last summer.

Insurers cited several reasons for the hike. One factor is the expiration of the enhanced premium tax credits, which pushed healthier enrollees to leave the marketplaces, leaving behind sicker beneficiaries who are more expensive to cover. Rising healthcare costs are driving premiums higher too, as hospitalizations, physician visits and prescription drugs (including expensive GLP-1 medications for weight loss) continue to increase spending. General inflation, high costs for healthcare labor and increasing claims severity are also contributing to heightened healthcare expenses.

Alignment Health is facing a whistleblower lawsuit from its former chief transformation officer, who alleges the company improperly classified $18–20 million of routine operating costs as capital expenditures in 2024–2025 to inflate profitability and retaliated against him after he raised concerns. Alignment denies the allegations, stating that an independent legal and accounting review found its financial reporting was appropriate, and says it will vigorously defend itself.