U.S. judge rules Leapfrog's safety ratings were unfair to nonparticipating hospitals
By Rick Mayer
March 9, 2026 at 11:14 AM EDT
The judge ordered Leapfrog to remove grades for five hospitals in the Palm Beach Health Network, which filed a lawsuit alleging misleading practices under Florida’s Deceptive and Unfair Trade Practices Act.
A U.S. District judge on Friday sided with a South Florida health system in ruling The Leapfrog Group stacked the deck against hospitals that declined to participate in the organization’s annual health safety surveys.
In an injunction, the judge ordered Leapfrog to remove safety grades for five Tenet-owned hospitals in the Palm Beach Health Network, which filed a lawsuit alleging misleading practices under Florida’s Deceptive and Unfair Trade Practices Act.
ALSO READ: South Florida hospitals, Leapfrog Group seek court ruling over safety grades
U.S. District Judge Donald Middlebrooks, of the Southern District of Florida, said he found the grading system, which automatically assigned the lowest possible scores to nonparticipating hospitals, could mislead the public about actual patient safety.
That’s what happened with the published grades of Good Samaritan Medical Center and St. Mary’s Medical Center in West Palm Beach; Delray Medical Center in Delray Beach; Palm Beach Gardens Medical Center; and West Boca Medical Center.
The facilities, all part of the Palm Beach Health Network, claimed the poor ratings Leapfrog assigned to them harmed patients and undermined trust.
Encouraging transparency and fairness
The ruling could reshape hospital ratings nationwide. Many rating organizations rely on voluntary self-reported data, and this decision challenges the practice of penalizing hospitals simply for not participating.
For patients, the case highlights that grades may not always reflect the full picture of hospital safety. For hospitals, it provides a shield against being automatically penalized for skipping a survey, while encouraging more transparent and fair rating systems.
ALSO READ: HCA, AdventHealth boost Florida to 15th in Leapfrog hospital safety rankings
The judge noted Leapfrog encouraged hospitals to submit data or purchase optional Leapfrog services, such as benchmarking tools, consulting or licensing the “A” grade logo for marketing.
The injunction also instructs Leapfrog to disclose to entities that paid to license surveys that used the misleading methodology (fall 2024, spring and fall 2025) that those safety grades were “deceptive and unfair.”
The judge called out Leapfrog president and CEO Leah Binder for suggesting that “imputing … the lowest score” would be a “very big deal to hospitals (and a major incentive to report to the survey).’”
The judge applied the Florida law that protects consumers from business practices deemed unfair or misleading. Courts can issue injunctions to halt unfair practices, but monetary damages do not automatically follow.
In this case, Palm Beach Health Network did not seek any money, only that Leapfrog stop using the disputed scoring methodology.
Appeal and compliance planned
In 2024, Leapfrog changed how it handled missing survey data. Previously, hospitals that skipped the voluntary survey might have gaps filled with averages or other publicly available information.
After the change, missing survey responses automatically triggered “Limited Achievement” — the lowest rating — on several key patient-safety measures, effectively penalizing nonparticipants.
Those measures included: computerized physician order entry, bar-code medication administration, intensive-care unit physician staffing, and hand hygiene monitoring.
The measures could account for about a third of the final safety grade, meaning nonparticipation could dramatically lower a score, even if performance was strong.
ALSO READ: Leapfrog Group sends cease-and-desist letter to five Florida Tenet hospitals that filed lawsuit
“Leapfrog’s practices harm the hospitals, insurers, employees, and patients; the only beneficiary of this methodology is Leapfrog itself,” Middlebrooks wrote.
Binder said the organization will appeal. For now, she said, Leapfrog will comply with the injunction and update its spring safety grades.
“We vehemently disagree with this decision, as we believe it threatens the First Amendment rights of every American,” Binder said in a statement on the group’s website. “If Leapfrog’s gold-standard transparency is considered ‘deceptive’ in Florida, no ratings system is safe from court intervention.”
She emphasized her company’s transparency, noting that every element of its methodology is public and accessible.
“If this decision was allowed to stand, the implications would seriously undermine all published ratings and reviews in all industries, not just Leapfrog’s ratings of the safety of hospitals,” Binder said. “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.”
In a statement, the five Tenet-owned hospitals said they are pleased with the ruling.
“Any organization influencing life-and-death health care decisions must be transparent, data-based and accountable,” the hospitals said. “We encourage hospitals and the healthcare industry to review today’s decision carefully and insist on rating systems that are transparent, scientifically grounded and fair.”
In an injunction, the judge ordered Leapfrog to remove safety grades for five Tenet-owned hospitals in the Palm Beach Health Network, which filed a lawsuit alleging misleading practices under Florida’s Deceptive and Unfair Trade Practices Act.
ALSO READ: South Florida hospitals, Leapfrog Group seek court ruling over safety grades
U.S. District Judge Donald Middlebrooks, of the Southern District of Florida, said he found the grading system, which automatically assigned the lowest possible scores to nonparticipating hospitals, could mislead the public about actual patient safety.
That’s what happened with the published grades of Good Samaritan Medical Center and St. Mary’s Medical Center in West Palm Beach; Delray Medical Center in Delray Beach; Palm Beach Gardens Medical Center; and West Boca Medical Center.
The facilities, all part of the Palm Beach Health Network, claimed the poor ratings Leapfrog assigned to them harmed patients and undermined trust.
Encouraging transparency and fairness
The ruling could reshape hospital ratings nationwide. Many rating organizations rely on voluntary self-reported data, and this decision challenges the practice of penalizing hospitals simply for not participating.
For patients, the case highlights that grades may not always reflect the full picture of hospital safety. For hospitals, it provides a shield against being automatically penalized for skipping a survey, while encouraging more transparent and fair rating systems.
ALSO READ: HCA, AdventHealth boost Florida to 15th in Leapfrog hospital safety rankings
The judge noted Leapfrog encouraged hospitals to submit data or purchase optional Leapfrog services, such as benchmarking tools, consulting or licensing the “A” grade logo for marketing.
The injunction also instructs Leapfrog to disclose to entities that paid to license surveys that used the misleading methodology (fall 2024, spring and fall 2025) that those safety grades were “deceptive and unfair.”
The judge called out Leapfrog president and CEO Leah Binder for suggesting that “imputing … the lowest score” would be a “very big deal to hospitals (and a major incentive to report to the survey).’”
The judge applied the Florida law that protects consumers from business practices deemed unfair or misleading. Courts can issue injunctions to halt unfair practices, but monetary damages do not automatically follow.
In this case, Palm Beach Health Network did not seek any money, only that Leapfrog stop using the disputed scoring methodology.
Appeal and compliance planned
In 2024, Leapfrog changed how it handled missing survey data. Previously, hospitals that skipped the voluntary survey might have gaps filled with averages or other publicly available information.
After the change, missing survey responses automatically triggered “Limited Achievement” — the lowest rating — on several key patient-safety measures, effectively penalizing nonparticipants.
Those measures included: computerized physician order entry, bar-code medication administration, intensive-care unit physician staffing, and hand hygiene monitoring.
The measures could account for about a third of the final safety grade, meaning nonparticipation could dramatically lower a score, even if performance was strong.
ALSO READ: Leapfrog Group sends cease-and-desist letter to five Florida Tenet hospitals that filed lawsuit
“Leapfrog’s practices harm the hospitals, insurers, employees, and patients; the only beneficiary of this methodology is Leapfrog itself,” Middlebrooks wrote.
Binder said the organization will appeal. For now, she said, Leapfrog will comply with the injunction and update its spring safety grades.
“We vehemently disagree with this decision, as we believe it threatens the First Amendment rights of every American,” Binder said in a statement on the group’s website. “If Leapfrog’s gold-standard transparency is considered ‘deceptive’ in Florida, no ratings system is safe from court intervention.”
She emphasized her company’s transparency, noting that every element of its methodology is public and accessible.
“If this decision was allowed to stand, the implications would seriously undermine all published ratings and reviews in all industries, not just Leapfrog’s ratings of the safety of hospitals,” Binder said. “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.”
In a statement, the five Tenet-owned hospitals said they are pleased with the ruling.
“Any organization influencing life-and-death health care decisions must be transparent, data-based and accountable,” the hospitals said. “We encourage hospitals and the healthcare industry to review today’s decision carefully and insist on rating systems that are transparent, scientifically grounded and fair.”