美國撤回對UnitedHealth的上訴,星級評分再度重算

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美國放棄對UnitedHealth Medicare計劃評級的上訴

(路透社)- 美國醫療保健和醫療補助服務中心(CMS)於週五表示,將不會對法院命令進行上訴,該命令要求CMS重新計算其對UnitedHealth私營管理的Medicare健康保險計劃給予的公共星級評級。UnitedHealth表示,這將令其損失數百萬美元的客戶。

該機構並未說明為何在僅三天前提出的上訴通知被撤回,目前尚不清楚這一舉措是否屬於特朗普新政府的更廣泛政策變化。

由於特朗普政府下令健康機構暫停公共溝通,CMS拒絕發表評論。UnitedHealth則沒有立即回應評論請求。

這起訴訟涉及UnitedHealth的Medicare優勢計劃,這些計劃是由聯邦Medicare計劃資助的私營管理健康保險計劃,主要針對65歲及以上的老年人以及某些殘疾美國人。

CMS為Medicare優勢計劃分配1至5顆星的評級,以幫助消費者在計劃之間做出選擇。UnitedHealth在其訴訟中表示,由於CMS測試撥打者尋求外語翻譯的單次不成功通話,其某些Medicare優勢計劃失去了半顆星的評級。

UnitedHealth表示,CMS在根據單次通話降低星級評級的做法上是任意和草率的,並指出測試撥打者的錯誤導致未能與代表取得聯繫。

德克薩斯州的一名聯邦法官在11月同意了這一觀點,並命令CMS重新計算星級評級。

其他保險公司,包括Elevance、Centene和Humana,也已就其所稱的不公平星級評級起訴CMS。

此前,CMS已在失去法院裁決後,重新計算了Elevance和非營利組織SCAN Health Plans的Medicare優勢計劃的星級評級。

UnitedHealth Group的股價上漲約0.6%,達到532.86美元。

分析評論:

這一事件不僅影響UnitedHealth的財務狀況,還可能引發對整個Medicare優勢計劃評級系統的重新審視。CMS的星級評級系統原本旨在幫助消費者選擇更合適的保險計劃,但如果評級的依據過於隨意或不充分,將會削弱其公信力和有效性。此外,這一事件也突顯了在醫療保險市場中,保險公司與監管機構之間的緊張關係,特別是在政策變動的背景下,未來可能會有更多類似的爭議出現。這對於其他保險公司來說也是一個警示,因為它們面臨著相似的評級挑戰,將需要更加謹慎地管理與CMS的關係。

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