WEST PALM BEACH, Fla. — A federal judge has ruled that The Leapfrog Group, a nonprofit that assigns safety grades to hospitals across the country, used unfair and deceptive tactics when assigning and publishing those grades.
According to a ruling posted Friday, the nonprofit must remove the grades of 5 Palm Beach County hospitals from its website by the end of the week. The 5 hospitals, all owned by Tenet Healthcare, sued the nonprofit over the grades in April 2025, arguing the organization ran a "pay for play" scheme to artificially boost ratings.
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U.S. District Judge Donald Middlebrooks said the alternative scoring measures the nonprofit used to evaluate hospitals that didn't participate in its survey — because it assumed those hospitals had something to hide — made it nearly impossible for those facilities to receive a passing grade. He also said Leapfrog's advisory panel of experts never voted to adopt the significant change in methodology.
"Leapfrog's change in methodology has no scientific basis, unfairly penalizes non-participating hospitals, and misrepresents hospital safety," Middlebrooks wrote. "For the reasons that follow, I find that Leapfrog's approach constitutes an unfair and deceptive business practice in violation of the Florida Deceptive and Unfair Trade Practices Act."
Middlebrooks referenced an email from Patrick Romano, then a professor of Medicine and Pediatrics for UC Davis Division of General Medicine and a member of the nonprofit's expert panel, addressing the decision to punish hospitals that don't respond to Leapfrog's survey.
"Their decision to increase the penalty for non-participation was a simple business decision, just like our decision not to participate," Romano wrote. "It's just business, folks. Their business model, as you know, depends on producing data that add value for health plans and employers and the data are not valuable if participation is low."
The trial, which lasted about 5 days earlier this year, featured testimony from around 5 local hospital CEOs describing the ways the safety rating was hurting their hospitals and patient health.
Cynthia McCauley, the CEO for St. Mary's, told the judge a brand analysis of the public's perception showed the percentage of patients who would choose St. Mary's dropped from 78% to 55% from the fourth quarter of 2024 to the second quarter of 2025. She also said her hospital saw a significant increase in transfers, particularly from a competing local "A"-rated hospital.
Delray Medical Center CEO Heather Havericak said a patient initially declined surgery at Delray because she was concerned about the hospital's safety grade and feared she would die there.
West Boca Medical Center CEO Jerad Hanlon said a patient verbalized multiple times that he wanted to go to a different hospital against medical advice because of the safety grade, even though West Boca is one of the few hospitals in the country with a dedicated hand surgery unit with specialized positions. Hanlon said the hospital also sustained financial harm because the patient had to receive a bill for intake and treatment provided prior to his departure, costs that would likely be incurred again at the next facility.
Maggie Gill, the eastern group president for the Palm Beach Health Network, said she was not surprised by the ruling.
"Leapfrog is made up data and they bully hospitals into participating so they can drive up their revenue," Gill said. "But there's not a methodology that really proves out patient safety and quality."
Gill said the grade is a poor reflection of the work the hospital network performs, but she declined to quantify the economic cost to the hospital system from a poor grade from The Leapfrog Group. She also said the hospital group participates in other safety surveys but declined to describe what data those surveys include that The Leapfrog Group could use to create a fair rating.
The Leapfrog Group, which according to its latest IRS filings made $8.3 million in 2023, said in a statement it plans to appeal the decision. The organization said it believes the ruling affects the ability of anyone to rate a product or service.
"The implications would seriously undermine all published ratings and reviews in all industries, not just Leapfrog's ratings of the safety of hospitals," Leapfrog President and CEO Leah Binder wrote. "The decision gives businesses in Florida the right to sue ratings organizations if they feel harmed by a rating of their product. Ratings everywhere are potentially at risk now, from Amazon to Experian to Moody's to Yelp."
Binder, who was compensated with $669,000 according to the nonprofit's latest tax filing for 2023, told me the organization would comply with the judge's order to remove the 5 hospitals' grades and would no longer issue a grade for hospitals that didn't complete the survey for its latest publication in Spring 2026. She said the organization plans to rework its methodology going forward.
"It's too soon to be able to redo the methodology," Binder said. "But for the fall, we are redoing the methodology so that we don't need this, this kind of imputation at all and we will grade all hospitals in the country with a new entirely new methodology that will enable us to also grade these 5 hospitals."
Binder also said she did not receive any complaints from Tenet Healthcare, which owns the Palm Beach Health Network, about the methodology before the suit was filed in April 2025.
"I also know they are owned by a 20 billion dollar corporation that has more than enough resources to quickly fix the problem that Leapfrog and many others find in their safety record," Binder said. "…But, instead they chose to spend those resources on this lawsuit."
Binder also acknowledged that many hospitals that don't participate in the survey — which takes staff about two weeks to complete — cannot receive an "A" rating from the nonprofit. She said this is because when data is unavailable, the organization assumes the hospital has something to hide. She acknowledged the decision was made after consulting an advisory panel, but said the panel does not have final say in the nonprofit's decisions.
"Expert panels don't vote," Binder said. "They don't vote. They reach consensus and then their consensus is communicated to those who make decisions about what happens in the end...That's how expert panels work. They're not congress. They're expert panels."