Vice President of Compliance

Alignment Health sues CMS over 2027 Star Ratings. Alignment Healthcare has sued HHS and CMS over its 2027 Medicare Advantage Star Ratings, one day after the agency's release showed its largest contract falling to 3.5 stars from 4. The California HMO contract, H3815, serves about 75 percent of the company's health plan membership, Alignment said in an Oct. 8 securities filing. The Alignment Health lawsuit matters to Medicare Advantage insurers because it challenges how CMS defines and changes star rating measures, an issue that has already produced one court loss for the agency. Star Ratings determine quality bonus payments, which total roughly $13 billion a year across the industry, according to published estimates. [TABLE OF CONTENTS] What the Alignment Health lawsuit claims. The suit, filed Oct. 9 in federal court in Washington, D.C., also names HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, according to published reports. Alignment asks the court to declare certain measures used in its 2027 ratings unlawful. The core argument is procedural. Alignment contends that CMS's governing statute requires star rating measures to be set by regulation through notice-and-comment rulemaking. Instead, the complaint says, CMS publishes measure specifications in annual sub-regulatory guidance known as Technical Notes, which it can change at its discretion, according to published accounts of the filing. "Once again, CMS has used the same ten measures in calculating Alignment's 2027 Star Ratings without first promulgating them 'by regulation,' as Congress expressly required," the complaint states, according to those accounts. The legality of those measures is already before the same court in Alignment's pending challenge to its 2026 ratings. The Clover precedent. Alignment's case draws on Clover Health's suit against HHS in federal court in Georgia. In a May 27 decision, the court ruled in Clover's favor on 20 measures, according to Clover's securities filings. On June 9, CMS informed Clover it had recalculated the 2026 rating for its PPO contract from 3.5 stars to 4.5 stars, and on June 17 it told all Medicare Advantage organizations it was voluntarily recalculating 2027 quality bonus payment ratings for certain contracts. For 2027, CMS calculated Clover's PPO rating without the 20 measures, awarding 5 stars. With those measures included, the PPO would have received 4.5 stars, Clover said in an Oct. 8 filing. CMS appealed the decision to the U.S. Court of Appeals for the 11th Circuit on July 21. Alignment argues it is entitled to the same treatment. According to published reports, the insurer asked CMS to calculate its 2027 ratings without the contested measures before filing suit. Financial stakes for Alignment. Alignment said it expects its six other eligible contracts to keep ratings of 4 stars or higher, including three at 4.5 stars. But because H3815 covers most members, the share of Alignment members in 4-star-or-higher plans falls to about 25 percent for 2027, from 100 percent in 2026, according to published reports. The company has said it could lose more than $200 million. In its filing, Alignment attributed the decline mainly to higher industry cut points and weaker results on certain triple-weighted Health Outcomes Survey and Part D measures. It also cited CMS's decision to retroactively eliminate bonus calculations tied to the Excellent Health Outcomes for All Index, formerly the Health Equity Index, after the performance period ended. The 2027 ratings will not affect revenue for 2026 or 2027, the company said. The impact falls on quality bonus payments in 2028, which Alignment plans to offset partly through risk-sharing arrangements with providers and earnings growth from newer members. What comes next. Alignment said it will also pursue administrative appeals. The outcome may depend on the 11th Circuit's ruling in the Clover case, which will address whether CMS can rely on measures not adopted through rulemaking. Other insurers, including SCAN Health Plan and Elevance Health, have previously challenged star ratings in court. A ruling for Alignment, or an appellate decision upholding Clover's win, could prompt CMS to move more measure specifications into formal regulation, which would change how the program is updated each year.

Humana (NYSE:HUM) hits new 12-month high - Here's what happened. October 9, 2026 Key points. * Humana shares reached a new 52-week high, trading as high as $456.50 after previously closing at $387.12, driven largely by optimism around its Medicare Advantage business. * Improved Medicare Advantage Star Ratings place 95% of Humana's members in plans rated four stars or higher for 2027, potentially boosting bonus revenue and supporting the company's longer-term recovery. * Analyst sentiment has generally improved, with Cantor Fitzgerald upgrading Humana to Overweight and Baird maintaining an Outperform rating, while the company reaffirmed its 2026 adjusted earnings outlook. * Interested in Humana? Here are five stocks we like better. Humana Inc. (NYSE:HUM - Get Free Report)'s share price reached a new 52-week high during trading on Friday. The company traded as high as $456.50 and last traded at $439.3370, with a volume of 941075 shares. The stock had previously closed at $387.12. More Humana news. Here are the key news stories impacting Humana this week: * Major improvement in plan quality ratings: Humana said 95% of its Medicare Advantage members are enrolled in plans rated four stars or higher for 2027, including 42% in 4.5-star plans. Six contracts received 4.5 stars and 12 received four stars. The improvement positions Humana as one of the biggest beneficiaries of the ratings cycle and could increase eligibility for quality-related bonus payments. * Potential earnings and revenue tailwind: Higher ratings may support bonus revenue and improve the competitiveness of Humana's Medicare Advantage offerings. Reports also said the company raised its outlook for 2028 Stars-related revenue, reinforcing expectations for a Medicare Advantage recovery. * Analyst sentiment improved: Baird and Barclays issued bullish commentary on Humana's Medicare Advantage recovery, while Cantor Fitzgerald raised its rating to Overweight. The ratings announcement has also led to comparisons showing Humana outperforming some rivals, including CVS and Alignment Healthcare. * 2026 outlook reaffirmed: Humana maintained its full-year adjusted earnings guidance, reducing the risk of an immediate outlook reset while leaving the improved Star Ratings as the primary new catalyst for investors. Wall Street Analyst weigh in. A number of research firms have recently commented on HUM. Lake Street Capital started coverage on Humana in a report on Thursday, July 30th. They set a "buy" rating for the company. Cantor Fitzgerald raised Humana from a "neutral" rating to an "overweight" rating and lifted their target price for the company from $300.00 to $460.00 in a research report on Wednesday. Wall Street Zen downgraded shares of Humana from a "buy" rating to a "hold" rating in a report on Sunday, September 27th. Robert W. Baird set a $596.00 target price on Humana and gave the stock an "outperform" rating in a report on Friday. Finally, JPMorgan Chase & Co. increased their price target on Humana from $316.00 to $393.00 and gave the stock a "neutral" rating in a report on Monday, August 10th. Seventeen analysts have rated the stock with a Buy rating, twelve have given a Hold rating and one has assigned a Sell rating to the stock. Based on data from MarketBeat, Humana presently has an average rating of "Moderate Buy" and an average target price of $445.74. Humana price performance. The firm has a 50-day moving average price of $387.26 and a 200-day moving average price of $332.87. The company has a debt-to-equity ratio of 0.62, a quick ratio of 1.74 and a current ratio of 1.74. The stock has a market cap of $51.97 billion, a P/E ratio of 40.93, a price-to-earnings-growth ratio of 2.45 and a beta of 0.74. Humana (NYSE:HUM - Get Free Report) last released its quarterly earnings results on Wednesday, July 29th. The insurance provider reported $7.61 EPS for the quarter, topping analysts' consensus estimates of $7.27 by $0.34. Humana had a net margin of 0.88% and a return on equity of 11.20%. The company had revenue of $40.89 billion for the quarter, compared to the consensus estimate of $40.58 billion. During the same period in the previous year, the firm earned $6.27 EPS. Humana's revenue was up 26.2% on a year-over-year basis. On average, analysts forecast that Humana Inc. will post 9.01 earnings per share for the current fiscal year. Humana dividend announcement. The firm also recently declared a quarterly dividend, which will be paid on Friday, November 27th. Shareholders of record on Friday, October 30th will be given a dividend of $0.8850 per share. The ex-dividend date of this dividend is Friday, October 30th. This represents a $3.54 dividend on an annualized basis and a yield of 0.8%. Humana's dividend payout ratio is presently 33.49%. Institutional investors weigh in on Humana. Hedge funds and other institutional investors have recently modified their holdings of the stock. Chapin Davis Inc. acquired a new stake in Humana during the 3rd quarter worth about $12,323,000. GAMMA Investing LLC raised its holdings in Humana by 27.4% during the third quarter. GAMMA Investing LLC now owns 1,996 shares of the insurance provider's stock valued at $762,000 after buying an additional 429 shares in the last quarter. Gradient Investments LLC raised its holdings in shares of Humana by 2.5% during the third quarter. Gradient Investments LLC now owns 13,738 shares of the insurance provider's stock valued at $5,242,000 after acquiring an additional 330 shares in the last quarter. Valeo Financial Advisors LLC lifted its stake in Humana by 15.3% in the third quarter. Valeo Financial Advisors LLC now owns 814 shares of the insurance provider's stock worth $310,000 after purchasing an additional 108 shares during the last quarter. Finally, Vista Investment Partners LLC purchased a new stake in shares of Humana during the 3rd quarter valued at approximately $3,254,000. Institutional investors own 92.38% of the company's stock. About Humana. Humana Inc is a health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, the company began as a nursing home operator before expanding into hospitals and health insurance. Today, Humana primarily provides health insurance products and healthcare services for older adults, individuals, military families and other members in the United States. Humana's insurance business offers Medicare Advantage, Medicare Supplement and prescription drug plans, as well as Medicaid coverage in select markets. Further reading. This instant news alert was generated by narrative science technology and financial data from MarketBeat in order to provide readers with the fastest reporting and unbiased coverage. 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