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A $190 million phone call: Medicare Advantage insurance giant accuses government of stripping bonus payments after one bad 'secret shopper' call
Elevance's lawsuit claims it was penalized over a single call that its call center never actually received, with a $500 million impact on 2025 revenue.
Elevance, which reports earnings Wednesday, is trying to grow its 2 million-member Medicare Advantage business to catch up with rivals like UnitedHealth Group Inc. and CVS Health Corp. Elevance’s star ratings dropped sharply in October and will be visible to consumers for the 2024 plan year. While the lawsuit revolves around $190 million in bonus payments, the company has said the ultimate impact of the lower rating will mean a $500 million reduction in revenue for 2025. The company expects to blunt the impact on profits.
Elevance says Centers for Medicare and Medicaid Services (CMS) penalized the insurer for a single call on March 23, 2023, placed through the federal 711 text telephone system, that the company’s call center never actually received. The government wrongly determined that Elevance “missed a single call, despite Defendants’ own evidence that the call never even connected to Plaintiffs’ phone lines through no fault of Plaintiffs,” the company said in the lawsuit. That missed call tipped the Elevance’s quality scores below a level that earns bonus payments, according to the lawsuit.
