A federal judge has ruled against the Leapfrog Group in a suit brought by Tenet Healthcare subsidiary hospitals that said they were punished for not voluntarily submitting data to the hospital safety grading nonprofit.
The ruling, handed down Friday, focuses on a methodology change Leapfrog implemented ahead of the fall 2024 publication of its hospital safety grades. The approach more heavily weighed “imputed” scores for four of Leapfrog’s 32 safety measures that were assigned when recent safety data for the two preceding years are unavailable.
Such an approach “deliberately” fails and defames hospitals that chose not to submit their data to Leapfrog, argued plaintiff hospitals that said they had been harmed by their poor grades.
A judge agreed, and, in his ruling, ordered Leapfrog to pull its poor ratings of the five plaintiff hospitals comprising the Palm Beach Health Network and refrain from scoring those hospitals using its current or similar methodology. Disclosures addressing the court’s ruling—that the methodology change was found by a court to be “deceptive and unfair” in violation of Florida law—must also be sent to all of its paid licensees since the change went into effect as well as in some future materials, the judge ordered.
“Leapfrog’s change in methodology has no scientific basis, unfairly penalizes non-participating hospitals, and misrepresents hospital safety,” Judge Donald M. Middlebrooks, of the U.S. District Court for the Southern District of Florida, wrote.
The plaintiffs filed their lawsuit in April 2025 after a series of correspondences between the parties in which Leapfrog rebuffed Tenet’s request to cease and desist publishing the ratings for those hospitals. Each had received either “F” or “D” grades from Leapfrog.
“We are pleased that the Court ordered meaningful relief,” Palm Beach Health Network wrote in a release celebrating the decision. “But this is bigger than five hospitals: any organization influencing life-and-death healthcare decisions must be transparent, data-based and accountable. We look forward to Leapfrog’s swift compliance with the Court’s order, and encourage hospitals and the healthcare industry to review today’s decision carefully and insist on rating systems that are transparent, scientifically grounded and fair.
Leah Binder, president and CEO of Leapfrog, told Fierce Healthcare in an interview that the organization will comply with the court’s injunction but plans to file an appeal.
Assuming no other legal changes, Leapfrog will move forward with the spring 2026 hospital safety grade release while excluding those five hospitals as well as all others impacted by the imputation methodology because “we do not pick and choose hospitals for different methodologies. We do one methodology for the safety grade for all hospitals,” she explained while promising further details to come.
The subsequent ratings release in the fall, she continued, “will have a new methodology that will allow us to grade those five hospitals and all hospitals in the United States, because that is our mission” of hospital safety transparency.
The judge, in his ruling, said “the evidence at trial did not bear out a dispositive answer to whether” the four imputed measures created a “meaningful difference” in a hospital’s grade, while noting that “several considerations supporting Plaintiff’s contention that the low assignments do, in fact, produce worse results.”
For the purposes of his analysis under Florida’s law, he said Leapfrog’s characterization of its grades are a full and accurate representation of patient safety were “deceptive … representations made to the consumers.”
He also agreed with the plaintiffs that poor ratings harmed the plaintiffs’ reputations among patients and others and found compelling the evidence and testimony suggesting that part of Leapfrog’s actions before and after the ratings were assigned were intended to coerce hospitals into participating, to the group’s own financial benefit.
“It appears that the goal to maximize revenue came at the cost of comprehensive and accurate Safety Grades,” the judge wrote. “The result is that various parties—the hospitals, their employees, the insurers and of course the patients themselves—were and are foreseeably injured.”
Binder said her organization was “shocked” and “vehemently opposed” to the judge’s decision and directly contradicted some of his conclusions.
She said the witnesses Leapfrog called upon in court had attested the methodology’s imputed scores were a common practice among ratings institutions and that the decision had not harmed the five hospitals’ scores. And, while the judge had noted that the change was not voted upon by the advisory board Leapfrog involves in its methodology decisions, she said such boards never hold votes and rather give recommendations by consensus—which they had done before she personally signed off on the change.
“I would never approve a methodology change of any sort—but particularly one like this—without knowing that every member the expert panel was behind it,” she said. “And they were. … The fact that we don’t vote on it is not traditional of any expert panel.”
More broadly, Binder said the judge choosing to weigh hospitals as “consumers” under the Florida statute raises “extremely disturbing ramifications” for any organization that rates or reviews businesses.
“To take that to another level: a business that gets a credit score from Moody’s and gets downgraded would have standing, according to this judge, to sue under this Florida statute because they’ve been harmed by a rating,” she said. “There’s no evidence presented at trial that that was an appropriate interpretation of this law … with chilling effects on the First Amendment for sure, and also on the ability of any organization to rate and criticize businesses.”