{
  "data_version": "1",
  "schema": "https://whatledto.com/data",
  "id": "cms",
  "name": "CMS",
  "kind": "regulator",
  "url": "https://whatledto.com/who/cms",
  "description": "",
  "same_as": [],
  "timelines": [
    {
      "slug": "medicare-advantage-2027",
      "title": "Medicare Advantage's Retreat: From the 2026 Rate Hike to the 2027 Plan Exits and Open Enrollment",
      "url": "https://whatledto.com/events/medicare-advantage-2027",
      "json": "https://whatledto.com/events/medicare-advantage-2027.json",
      "role": "Federal agency whose Medicare Advantage payments were implicated by the alleged coding.",
      "entries": 8,
      "updated_at": "2026-10-14T02:01:40.262749+00:00"
    }
  ],
  "entries": [
    {
      "timeline": "medicare-advantage-2027",
      "id": 2139,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n2139",
      "date": "2026-10-09",
      "date_precision": "day",
      "title": "Alignment Healthcare sues CMS over 2027 star-ratings methodology",
      "summary": "Alignment Healthcare filed a lawsuit against CMS in District of Columbia federal court over the methodology for 2027 Medicare Advantage Star Ratings. The insurer alleged that CMS departed from a system of predictable, valid measures developed with input from providers, plans, and the public.",
      "type": "legal",
      "entities": [
        "Alignment Healthcare",
        "CMS",
        "District of Columbia federal court",
        "Medicare Advantage"
      ],
      "parties": [
        "alignment-healthcare",
        "cms",
        "district-of-columbia-federal-court",
        "medicare-advantage"
      ],
      "sources": [
        {
          "url": "https://www.fiercehealthcare.com/payers/alignment-healthcare-sues-cms-over-its-2027-medicare-advantage-star-ratings",
          "outlet": "Fierce Healthcare",
          "published": "2026-10-12",
          "quote": "In the lawsuit filed Friday in District of Columbia federal court, the insurer says that the Centers for Medicare & Medicaid Services \"has completely departed from Congress’s vision of leveraging predictable, valid measures developed with input from providers, plans, and the public\" in establishing the methodology for the star ratings."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 2137,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n2137",
      "date": "2026-10-08",
      "date_precision": "day",
      "title": "Clover Health says its PPO MA plans earned five stars for 2027",
      "summary": "Clover Health said CMS awarded its PPO Medicare Advantage plans five stars and its HMO plan 4.5 stars for 2027. Clover Health said the ratings would affect payment year 2028.",
      "type": "announcement",
      "entities": [
        "Clover Health",
        "CMS",
        "Medicare Advantage"
      ],
      "parties": [
        "clover-health",
        "cms",
        "medicare-advantage"
      ],
      "sources": [
        {
          "url": "https://investors.cloverhealth.com/news-releases/news-release-details/clover-health-medicare-advantage-ppo-plans-earn-5-star-rating",
          "outlet": "Clover Health",
          "published": "2026-10-08",
          "quote": "Clover Health Investments, Corp. (Nasdaq: CLOV) (“Clover,” “Clover Health” or the “Company”), today announced that the Centers for Medicare & Medicaid Services (“CMS”) has awarded its PPO Medicare Advantage (“MA”) plans a rating of 5 Stars and its HMO MA plan a rating of 4.5 Stars for 2027, which will affect payment year 2028."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 2136,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n2136",
      "date": "2026-10-08",
      "date_precision": "day",
      "title": "Aetna says over 69 percent of MA members are in four-star plans",
      "summary": "Aetna said more than 69% of its Medicare Advantage members were in 2027 plans rated four stars or higher. The ratings were assigned by CMS.",
      "type": "announcement",
      "entities": [
        "Aetna",
        "CMS",
        "Medicare Advantage"
      ],
      "parties": [
        "aetna",
        "cms",
        "medicare-advantage"
      ],
      "sources": [
        {
          "url": "https://investors.cvshealth.com/news/news-details/2026/Aetna-2027-Star-Ratings-Reflect-Strong-Clinical-Quality-and-Member-Experience/default.aspx",
          "outlet": "CVS Health/Aetna",
          "published": "2026-10-08",
          "quote": "announced today that more than 69 percent of its Medicare Advantage (MA) members are in 2027 plans rated 4 stars or higher (out of 5 stars) by the Centers for Medicare & Medicaid Services (CMS)."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 2135,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n2135",
      "date": "2026-10-08",
      "date_precision": "day",
      "title": "Humana says 95 percent of MA members are in four-star plans",
      "summary": "Humana said 95% of its Medicare Advantage members were enrolled in plans rated four stars or higher for 2027. Healthcare Dive reported that its analysis of CMS data put Humana's corresponding percentage at 93%.",
      "type": "announcement",
      "entities": [
        "Humana",
        "CMS",
        "Medicare Advantage",
        "Healthcare Dive"
      ],
      "parties": [
        "humana",
        "cms",
        "medicare-advantage",
        "healthcare-dive"
      ],
      "sources": [
        {
          "url": "https://policy.humana.com/news-and-resources/news-press/2026/humana-announces-improved-cms-star-ratings-with-95-percent-of",
          "outlet": "Humana",
          "published": "2026-10-08",
          "quote": "today announced improved Star Ratings for 2027, highlighted by 95% of its Medicare Advantage members being enrolled in plans rated 4.0 stars or above by the Centers for Medicare and Medicaid Services (CMS)."
        },
        {
          "url": "https://www.healthcaredive.com/news/medicare-advantage-stars-2027-winners-losers/832582/",
          "outlet": "Healthcare Dive",
          "published": "2026-10-09",
          "quote": "Humana, which suffered a major ratings collapse two years ago, saw the percentage of its members in 4+star plans rocket from 41% in 2026 to 93% in 2027, according to a Healthcare Dive analysis of stars data released Thursday by the CMS."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 2134,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n2134",
      "date": "2026-10-08",
      "date_precision": "day",
      "title": "CMS releases 2027 Medicare Advantage and Part D star ratings",
      "summary": "CMS released its 2027 Star Ratings for Medicare Advantage and Medicare Part D plans. CMS said 188 MA-PD contracts, approximately 37% of those offered in 2027, earned four stars or higher.",
      "type": "regulatory",
      "entities": [
        "CMS",
        "Medicare Advantage",
        "Medicare Part D",
        "Alignment Healthcare"
      ],
      "parties": [
        "cms",
        "medicare-advantage",
        "medicare-part-d",
        "alignment-healthcare"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/newsroom/fact-sheets/2027-medicare-advantage-part-d-star-ratings",
          "outlet": "CMS",
          "published": "2026-10-08",
          "quote": "Approximately 37% of MA-PDs (188 contracts) that will be offered in 2027 earned four stars or higher for their 2027 overall rating."
        },
        {
          "url": "https://www.sec.gov/Archives/edgar/data/1832466/000162828026065470/alhc-20261008.htm",
          "outlet": "Alignment Healthcare SEC Form 8-K",
          "published": "2026-10-08",
          "quote": "On October 8, 2026, the Centers for Medicare & Medicaid Services (“CMS”) released its 2027 Star Ratings for Medicare Advantage (“Medicare Part C”) and Medicare Part D prescription drug plans."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 1621,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n1621",
      "date": "2026-09-28",
      "date_precision": "day",
      "title": "CMS projects about 5,532 Medicare Advantage plans for 2027",
      "summary": "CMS projected approximately 5,532 Medicare Advantage plans nationally for 2027. It said the figure would be down from 5,553 plans in 2026.",
      "type": "announcement",
      "entities": [
        "CMS",
        "Medicare Advantage"
      ],
      "parties": [
        "cms",
        "medicare-advantage"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2027",
          "outlet": "CMS",
          "published": "2026-09-28",
          "quote": "The total number of available MA plans nationally is expected to remain relatively stable, changing from 5,553 in 2026 to approximately 5,532 in 2027."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 1501,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n1501",
      "date": "2026-09-04",
      "date_precision": "day",
      "title": "MedPAC reports variation in risk-standardized MA plan bids",
      "summary": "The Medicare Payment Advisory Commission presented preliminary analysis of 2024 Medicare Advantage HMO and PPO bids. It found that the 90th-percentile risk- and geography-standardized bid was about 40 percent higher than the 10th-percentile bid.",
      "type": "report",
      "entities": [
        "Medicare Payment Advisory Commission",
        "Medicare Advantage organizations",
        "CMS"
      ],
      "parties": [
        "medicare-payment-advisory-commission",
        "medicare-advantage-organizations",
        "cms"
      ],
      "sources": [
        {
          "url": "https://www.medpac.gov/wp-content/uploads/2026/09/Tab-F-MA-risk-adjustment-Sept-2026.pdf",
          "outlet": "Medicare Payment Advisory Commission",
          "published": "2026-09-04",
          "quote": "After risk and geographic standardization, 90th percentile bid was about 40 percent higher than 10th percentile bid."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 1500,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n1500",
      "date": "2026-08-26",
      "date_precision": "day",
      "title": "The Villages Health System agrees to $541.5 million FCA settlement",
      "summary": "The Villages Health System agreed to a $541.5 million settlement resolving self-disclosed False Claims Act allegations concerning Medicare Advantage diagnosis codes. The U.S. Department of Justice alleged that unsupported codes increased Medicare Advantage payments; the settlement did not determine liability.",
      "type": "legal",
      "entities": [
        "The Villages Health System",
        "U.S. Department of Justice",
        "CMS",
        "Humana",
        "UnitedHealthcare",
        "GuideWell",
        "Florida Blue"
      ],
      "parties": [
        "the-villages-health-system",
        "us-department-of-justice",
        "cms",
        "humana",
        "unitedhealthcare",
        "guidewell",
        "florida-blue"
      ],
      "sources": [
        {
          "url": "https://www.justice.gov/opa/pr/villages-health-system-llc-agrees-5415m-settlement-resolve-false-claims-act-allegations",
          "outlet": "U.S. Department of Justice",
          "published": "2026-08-26",
          "quote": "The Villages Health System LLC (TVH), a healthcare provider group headquartered in The Villages, Florida, has agreed to a $541.5 million settlement to resolve self-disclosed allegations that it violated the False Claims Act by causing the submission of false diagnosis codes in order to increase payments that they received from the Medicare Advantage program."
        },
        {
          "url": "https://www.healthcaredive.com/news/the-villages-health-medicare-overbilling-settlement-doj-humana/828915/",
          "outlet": "Healthcare Dive",
          "published": "2026-08-27",
          "quote": "The Villages Health, a healthcare provider in Central Florida, has agreed to pay $541.5 million to settle allegations that it overbilled Medicare, the Department of Justice announced Wednesday."
        }
      ]
    }
  ],
  "often_with": [
    {
      "id": "wells-fargo",
      "name": "Wells Fargo",
      "url": "https://whatledto.com/who/wells-fargo",
      "json": "https://whatledto.com/who/wells-fargo.json",
      "shared_timelines": 1
    },
    {
      "id": "us-government-accountability-office",
      "name": "U.S. Government Accountability Office",
      "url": "https://whatledto.com/who/us-government-accountability-office",
      "json": "https://whatledto.com/who/us-government-accountability-office.json",
      "shared_timelines": 1
    },
    {
      "id": "us-congress",
      "name": "U.S. Congress",
      "url": "https://whatledto.com/who/us-congress",
      "json": "https://whatledto.com/who/us-congress.json",
      "shared_timelines": 1
    },
    {
      "id": "us-department-of-justice",
      "name": "U.S. Department of Justice",
      "url": "https://whatledto.com/who/us-department-of-justice",
      "json": "https://whatledto.com/who/us-department-of-justice.json",
      "shared_timelines": 1
    },
    {
      "id": "house-ways-and-means-committee",
      "name": "House Ways and Means Committee",
      "url": "https://whatledto.com/who/house-ways-and-means-committee",
      "json": "https://whatledto.com/who/house-ways-and-means-committee.json",
      "shared_timelines": 1
    },
    {
      "id": "robert-f-kennedy-jr",
      "name": "Robert F. Kennedy Jr.",
      "url": "https://whatledto.com/who/robert-f-kennedy-jr",
      "json": "https://whatledto.com/who/robert-f-kennedy-jr.json",
      "shared_timelines": 1
    },
    {
      "id": "department-of-health-and-human-services",
      "name": "Department of Health and Human Services",
      "url": "https://whatledto.com/who/department-of-health-and-human-services",
      "json": "https://whatledto.com/who/department-of-health-and-human-services.json",
      "shared_timelines": 1
    },
    {
      "id": "centers-for-medicare-medicaid-services",
      "name": "Centers for Medicare & Medicaid Services",
      "url": "https://whatledto.com/who/centers-for-medicare-medicaid-services",
      "json": "https://whatledto.com/who/centers-for-medicare-medicaid-services.json",
      "shared_timelines": 1
    }
  ],
  "license": {
    "holder": "What Led To",
    "terms": "https://whatledto.com/methodology#reuse",
    "summary": "Quote entries with attribution and a link to the entry; do not republish whole timelines or train models on the text."
  }
}