Jane MusgraveFederal judge orders one rating agency to remove Tenet’s low marks, but ratings set by others remain unchanged.
When a federal judge this month ruled that a national watchdog group improperly gave Tenet Healthcare’s five medical centers in Palm Beach County F and D scores for safety and ordered it to remove the damning marks from its website, officials of the Dallas-based chain cheered.
But the owner of some of the biggest for-profit hospitals in the county wasn’t interested in talking about the poor ratings its medical centers received from other rating agencies, including the U.S. Centers for Medicare and Medicaid Services.
A spokesperson was happy to share information about Tenet’s successful lawsuit against The Leapfrog Group, a Washington-based nonprofit.
But he declined to answer questions about the one-star rating four of its hospitals got from CMS or the two-star rating the other received.
The five hospitals — Good Samaritan, Palm Beach Gardens, St. Mary’s, West Boca and Delray medical centers — also received low ratings from HealthLocator, run by the Mayo Clinic.
In a statement, Tenet lauded the March 6 decision by U.S. District Judge Donald Middlebrooks.
Middlebrooks, appointed in 1997 by President Bill Clinton, ruled that Leapfrog violated Florida’s Deceptive and Unfair Trade Practices Act by unfairly punishing Tenet hospitals with low scores because it didn’t participate in a survey Leapfrog uses, in part, to judge hospital performance.
The methodology Leapfrog uses to survey roughly 3,000 hospitals “has no scientific basis, unfairly penalizes non-participating hospitals, and misrepresents hospital safety,” Middlebrooks wrote in a blistering 41-page opinion that began with a giant “F.”
He wrote that the rating agency engaged in “bullying conduct” that violates Florida law.
“This bullying conduct is oppressive because non-participating hospitals face a severe penalty, and it is unscrupulous because the record shows that Leapfrog is not forthcoming to the public about how it calculates its Safety Grades or what they represent,” Middlebrooks concluded.
Maggie Gill, eastern group president of the Palm Beach Health Care Network, which operates the five county hospitals for Tenet, applauded the ruling.
“We hope this decision leads to meaningful changes nationwide, so that hospitals are no longer subjected to Leapfrog’s deceptive grading system and pressure tactics,” she said in a statement.
Vowing to appeal the ruling she “vehemently” disagreed with, Leapfrog’s president and CEO said Gill’s concern is misplaced. What Gill should be concerned about is patient safety, said Leah Binder, who has headed up the hospital watchdog group for nearly two decades.
“What that tells me is that they aren’t concerned about the substance of the ratings,” she said. “It’s such a disservice to the community they serve. It’s unconscionable.”
‘Because it is not good’
Middlebrooks didn’t rule that the five hospitals Tenet operates in the county were safe.
Instead, he ruled that the methodology Leapfrog used to calculate scores in four of 32 categories was flawed. The methodology was changed to encourage hospitals to complete the survey. The $20 billion publicly traded company’s refusal to fill out the surveys contributed to the F and D grades its hospitals received in the biannual reports beginning in fall 2024.
Less than six months later, in April 2025, the five Tenet hospitals sued Leapfrog.
During a five-day trial in January, attorneys representing Leapfrog pointed out that presenting information, proving its hospitals were safe, would have been the easiest way for Tenet to challenge the poor grades.
“They didn’t provide it to Leapfrog. … They didn’t provide it to us in discovery. They didn’t provide it to their own experts and they are not going to provide it in this trial,” Leapfrog attorney Kimberly Blair said in her opening statement. “Why? Because it is not good.”
The bulk of the information Leapfrog uses to judge hospital performance comes from reports hospitals are required to submit to CMS. It supplements that with information hospitals provide on the surveys.
CMS also annually rates hospitals using the data it collects, including patient surveys. In its most recent ratings, it gave Good Samaritan, St. Mary’s, Palm Beach Gardens and Delray medical centers, overall ratings of one star. West Boca Medical Center received two stars.
Rankings from the Mayo Clinic, which are also based on reports filed with CMS, were similar. Delray, Good Samaritan and Palm Beach Gardens medical centers were ranked in the bottom 10% of all hospitals in the country. St. Mary’s was ranked in the bottom 12% and West Boca was ranked in the bottom 20%.
The nonprofit Jupiter Medical Center did the best on both surveys, receiving four stars from CMS and was ranked as better than 71% of hospitals in the country by Mayo. It also got high marks from Leapfrog.
‘They are trying to scare our patients’
Binder suspects that Tenet went after Leapfrog because it aggressively publicizes its findings. Its ratings come up first on a Google search of “hospital grades” and its website is easy to navigate. It gets 3.5 million visitors annually.
CMS sends emails to Medicare recipients about its rankings, encouraging people to check the ratings of hospitals in their communities. Its data also comes up in a Google search, but it’s not user-friendly.
Mayo’s HealthLocator is new. It launched in October.
During the trial, Tenet’s attorneys blasted Leapfrog for using Google ads, press releases and even TikTok videos to publicize its findings.
“They are trying to scare our patients, our physicians, our communities referring to harm and errors, saying that only the worst of the worst get an F or a D,” said Tenet attorney Mary Beth Maloney. “In fact, they report that only the worst of the worst get an F.”
It’s all part of a “media machine” to punish hospitals that don’t fill out the surveys, Maloney said.
Binder made no apologies for promoting Leapfrog’s findings.
Medical errors, accidents, injuries and infections cause nearly 250,000 patient deaths a year, she said. Her agency was formed with the belief that by rating hospitals, people could make informed choices. It also hoped the grades would spur medical centers to improve patient safety and reduce preventable deaths.
“So, yeah, we’re all in on the PR,” Binder said.
She said she hopes Middlebrooks’ ruling will be reversed on appeal.
In the meantime, she said Leapfrog will follow his orders to remove the poor ratings Tenet hospitals received and those of other hospitals in the country that didn’t submit surveys.
Grades will be adjusted in the semiannual rating report that is to be released in the next several weeks to reflect Middlebrooks’ concerns, she said.
But, Binder said, she also hopes it will spur Tenet to act.
“I hope they take from this lawsuit that they should do something to improve patient safety,” she said. “Otherwise, they won and the people of South Florida lost.”
