Background
Alignment Healthcare, a provider of Medicare Advantage plans, challenged a decision by the Centers for Medicare and Medicaid Services to deny its request to disregard survey results for two contracts. Alignment claimed that Spanish-speaking enrollees received surveys in English contrary to their preferences, which it argued violated CMS Protocols and rendered the data unreliable. The district court granted summary judgment for the Department of Health and Human Services, and Alignment appealed.
The court’s reasoning
The court reviewed the agency action under the arbitrary and capricious standard. It found that the survey vendor had matched language preference data with the CMS sample file as well as possible using a conservative approach to avoid mismatches. The court noted that the Protocols required Spanish surveys to be made available but did not mandate that vendors send Spanish-only questionnaires in all cases. The court also held that Alignment forfeited its Chenery doctrine argument by failing to raise it in the district court. Additionally, the court found no evidence that the agency treated Alignment differently from similarly situated plans or that the regulatory scheme violated the private nondelegation doctrine.
Alignment fails to establish that its request was disregarded. Similarly, to the extent Alignment challenges the adequacy of CMS’s action or explanation, that challenge fails because CMS examined Alignment’s concerns and explained why there was no indication of survey administration error.
ALIGNMENT HEALTHCARE INC v. UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, No. 25-5239 (D.C. Cir. July 14, 2026)
What it means going forward
The decision reinforces the deference given to agency expertise in complex data analysis and survey administration for Medicare Advantage ratings. It clarifies that plans must raise specific legal objections regarding agency reasoning at the district court level to preserve them for appeal.