A federal judge has ordered the hospital ratings group Leapfrog to stop assigning its influential safety grades to five South Florida hospitals based on an “unfair and deceptive” methodology that saddled them with lower scores because they refused to provide data.

The ruling is a major victory for the hospitals, which have been rocked by Leapfrog’s “F” and “D” safety grades plus low ratings from Medicare. Leapfrog, a nonprofit organization, will remove the 2024-2025 safety grades for the five hospitals and temporarily stop grading all hospitals that decline to participate in its ratings process.

Federal District Judge Donald M. Middlebrooks ruled that Leapfrog engaged in “bullying conduct.”

“Nonparticipating 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 wrote. “These practices produced real harms.”

Leapfrog defended its “transparency” and promised to appeal. Meanwhile, a law professor said the ruling ignores important First Amendment concerns, although the prospects for a successful appeal are uncertain.

New Methodology, Poorer Safety Grades

The lawsuit claimed that Leapfrog wrongly adjusted several measures that it uses to calculate its safety grades — letter grades from A to F — for the 15%-20% of hospitals that refused to respond to its surveys.

Leapfrog’s safety grades are available to the public online, and hospitals can license them for marketing and publicity.

The safety grades are based on an analysis of 30 measures. Starting with its fall 2024 ratings report, Leapfrog changed how it calculated scores for hospitals that declined to participate and hadn’t provided recent data: It automatically gave them the lowest rating possible on 4 of the measures — Computerized Physician Order Entry, Bar Code Medication Administration, ICU Physician Staffing, and Hand Hygiene Score.

As of the fall 2024 report, safety grades for all five of the South Florida hospitals dipped to rock-bottom levels: Good Samaritan (West Palm Beach), Delray (Delray Beach), and Palm Beach Gardens got “F” grades, and West Boca (Boca Raton) and St. Mary’s (West Palm Beach) got “D” grades. The hospitals continued to score only “D” and “F” grades in the spring 2025 and fall 2025 ratings.

In spring 2024, prior to the change in methodology, the grades were “C,” “D,” “C,” “D,” and “C,” respectively.

Hospitals Already Had a Public Perception Problem

The lawsuit contended that the safety scores hurt the reputation of the hospitals. The CEO of St. Mary’s testified that an analysis of the public perception of the hospital found that the percentage of patients who would choose it fell from 78% to 55% from the last quarter of 2024 to the second quarter of 2025, and “the only thing that changed in a year was the Leapfrog rating.”

However, the hospitals were already struggling in the public eye.

All had notably low scores from Medicare’s hospital comparison tool in spring of 2025. On a 5-star scale, Good Samaritan and St. Mary’s both had 1-star overall ratings and 1-star patient satisfaction ratings. Palm Beach Gardens had a 1-star overall rating and a 2-star patient-satisfaction rating. West Boca and Delray both had 2-star overall ratings and 1-star patient-satisfaction ratings.

Since then, Good Samaritan’s patient satisfaction rating improved to 2 stars out of 5, while Delray’s overall rating fell to 1 star. The other ratings remain the same.

Hospital Chain Accuses Leapfrog of ‘Deception and Coercion’

In the new ruling, issued March 6, the judge ordered Leapfrog to stop rating the five hospitals under the current or similar methodology and remove their safety grades for fall 2024, spring 2025, and fall 2025. Leapfrog must alert the entities that licensed its safety grades “that those safety grades were found to be deceptive and unfair.”

In a statement, Maggie Gill, MBA, president of Eastern Group, Tenet Healthcare, said “This ruling validates what hospitals across the country have experienced firsthand: Leapfrog is an organization built on deceptive and unfair practices that harms the very same patients it claims to serve.”

She added that “we brought this lawsuit because patients deserve transparency. Hospitals should no longer be coerced into participating in a rating system or subjected to so-called ‘safety grades’ based on made-up data.”

Nonparticipating Hospitals Get a Break — for Now

Leah Binder, Leapfrog’s president and CEO, said in an interview that the company will go further than the ruling and not provide any safety grades for nonparticipating hospitals in its spring 2026 report, which is expected in late April or early May.

“For the next round, which is due in fall of 2026, we will have a brand-new methodology for the entire country,” she said. According to her, all nonparticipating hospitals will receive grades at that time.

As for the ruling itself, Binder promised that Leapfrog will appeal. “We’re outraged. We couldn’t disagree more with the finding,” she said. “It’s really overreach, and it’s an attack on an organization that has been the gold standard of transparency in any kind of rating. We have a right to our opinion, especially as we’ve made it very clear exactly how we derive that opinion.”

Binder said Leapfrog changed its methodology because “we were starting to assign very high scores to hospitals that declined to participate in the survey and declined to provide the data. It was clear to us that we were very likely overstating the performance of the hospitals.”

Law Professor Says First Amendment Rights Are at Stake

Eric Goldman, JD, MBA, professor with Santa Clara University School of Law, Santa Clara, California, noted that the judge clearly thinks Leapfrog is “intentionally trying to coerce participation [in its rating system] through nefarious means.”

However, the judge didn’t address free speech issues raised by the lawsuit, Goldman said. The First Amendment protects opinion, and opinion includes ratings, he added.

It’s not clear what will happen if the ruling is appealed to a higher court, Goldman said. For now, he cautioned hospitals against celebrating the ruling.

In the absence of hospital rating systems such as Leapfrog, he said, patients could turn to word-of-mouth or other sources of information that “rely on even worse criteria.” 

Goldman declared having no disclosures.