The Leapfrog lawsuit is a federal case in which five South Florida hospitals owned by Tenet Healthcare sued The Leapfrog Group over its Hospital Safety Grade program, and in March 2026 a federal judge ruled that Leapfrog’s grading methodology was deceptive and unfair under Florida consumer protection law. The judge ordered Leapfrog to remove the challenged grades and stop grading hospitals that decline to participate in its voluntary survey using the same approach. Leapfrog responded by pulling grades for 450 hospitals nationwide.1U.S. District Court, S.D. Florida. Order Re Bench Trial, Good Samaritan Medical Center v. The Leapfrog Group2Healthcare Dive. Leapfrog Must Remove Safety Grades for Five Tenet-Owned Hospitals, Judge Says
Who Sued and Where
The complaint was filed on April 30, 2025, in the U.S. District Court for the Southern District of Florida, case number 9:25-cv-80526-DMM. The five plaintiff hospitals, all part of the Palm Beach Health Network, are Good Samaritan Medical Center, Delray Medical Center, Palm Beach Gardens Medical Center, St. Mary’s Medical Center, and West Boca Medical Center. Gibson Dunn represented the hospitals, with Mary Beth Maloney as lead trial counsel.3U.S. District Court, S.D. Florida. Order Re Bench Trial4Gibson Dunn. Litigators of the Week
The Leapfrog Group is a national nonprofit that assigns A-through-F letter grades to roughly 2,800 general hospitals twice a year. Its Hospital Safety Grade program combines publicly available federal data from the Centers for Medicare and Medicaid Services with information hospitals voluntarily submit through the Leapfrog Hospital Survey. The survey itself is free, but Leapfrog earns revenue by licensing its data and safety-grade branding.5Hospital Safety Grade. About the Leapfrog Group6The Leapfrog Group. Facts About the Leapfrog Group
The Methodology Change at the Center of the Case
Beginning with its fall 2024 report, Leapfrog changed how it scored hospitals that did not participate in the voluntary survey. Previously, when a hospital had no recent data on four measures — computerized physician order entry, bar-code medication administration, ICU physician staffing, and hand hygiene — Leapfrog filled the gap with the average score of similar U.S. hospitals. Under the new approach, nonparticipating hospitals were assigned a “Limited Achievement” label representing the lowest performance category, with point values of 5 out of 100 for ICU physician staffing, 15 for computerized physician order entry, 15 for hand hygiene, and 25 for bar-code medication administration.3U.S. District Court, S.D. Florida. Order Re Bench Trial7Medscape. Judge Orders Influential Hospital Rating Group to Delete Grades
The effect on the Palm Beach Health Network hospitals was steep. In 2021, while participating in the survey, they had earned total scores of roughly 370 out of 400. After they stopped participating and the new methodology took hold, their scores fell to about 60 out of 400. Good Samaritan, Delray, and Palm Beach Gardens dropped to F grades in fall 2024. West Boca and St. Mary’s received Ds. Those grades persisted through spring and fall 2025.8Healthcare Dive. Leapfrog Must Remove Safety Grades9Medscape. Judge Orders Rating Group to Delete Grades
The court later found that the change had not been approved by Leapfrog’s own expert advisory panel or voted on by its board of directors. An internal advisory panel member described the decision as “a simple business decision” and a “backdoor approach to penalizing nonparticipation.” CEO Leah Binder had acknowledged internally that assigning the lowest score would be “a major incentive to report to the survey.” Participation did rise, from 64% of eligible hospitals in 2023 to 79% afterward.3U.S. District Court, S.D. Florida. Order Re Bench Trial
What the Hospitals Argued
The hospitals sued under the Florida Deceptive and Unfair Trade Practices Act (FDUTPA), amending the complaint in August 2025 to seek only injunctive relief, not damages.10WUSF. Judge Rules Leapfrog’s Safety Ratings Unfair Their core claim: the grades assigned to nonparticipating hospitals did not measure actual safety and instead functioned as punishment for declining to complete the voluntary survey. Because patients, insurers, and employers were led to treat the grades as objective safety assessments, that mismatch was deceptive.8Healthcare Dive. Leapfrog Must Remove Safety Grades
Tenet also alleged what it called a “brazen pay-to-play scheme,” in which Leapfrog sold memberships and used its grades to pressure hospitals into buying consulting services, benchmarking tools, and logo licenses. The Palm Beach Health Network’s opening press release said Leapfrog rewards hospitals that “either pay or supply free data” with higher grades while assigning “artificially low ratings” to those that do not participate.11HealthExec. Court Rules Leapfrog Hospital Safety Grades Deceptive12Palm Beach Health Network. Five Hospitals File Legal Complaint Against The Leapfrog Group
What Judge Middlebrooks Ruled
After a five-day bench trial in January 2026, U.S. District Judge Donald M. Middlebrooks issued his ruling on March 6, 2026, siding with the hospitals.13Gibson Dunn. Gibson Dunn Secures Trial Victory He found the revised methodology violated FDUTPA on two grounds. It was unfair, because assigning rock-bottom scores for nothing more than declining a voluntary survey caused substantial harm not outweighed by any benefit. And it was deceptive, because Leapfrog marketed its grades as based on “real data” and actual safety performance while the scores for nonparticipating hospitals reflected only nonparticipation. The court also faulted Leapfrog’s visual presentation, including gauge-style graphics that implied every displayed score was rooted in empirical evidence.3U.S. District Court, S.D. Florida. Order Re Bench Trial
The opinion used sharp language. Middlebrooks wrote that the methodology “has no scientific basis, unfairly penalizes non-participating hospitals, and misrepresents hospital safety.”8Healthcare Dive. Leapfrog Must Remove Safety Grades9Medscape. Judge Orders Rating Group to Delete Grades14Fierce Healthcare. Leapfrog Ordered to Remove Safety Grade for Five Tenet Hospitals15WUSF. Judge Rules Leapfrog’s Safety Ratings Unfair
What the Injunction Requires
The court ordered Leapfrog to:
- Remove the safety grades assigned to the five plaintiff hospitals for fall 2024, spring 2025, and fall 2025 from its websites.
- Notify all entities that licensed those grades that a court found them to be “deceptive and unfair,” and include similar disclosures in future licensing materials.
- Stop assigning grades to the five hospitals using the current methodology or anything substantially similar.
- Temporarily stop grading all hospitals that decline to participate in its rating process.
Although the order technically named only the five plaintiffs, the fourth requirement swept in every nonparticipating hospital nationwide.9Medscape. Judge Orders Rating Group to Delete Grades13Gibson Dunn. Gibson Dunn Secures Trial Victory
Why 450 Hospitals Lost Their Grades
Leapfrog decided to apply the injunction across the entire program rather than carve out only the plaintiffs. When it released its spring 2026 Hospital Safety Grades on May 6, 2026, it excluded 450 hospitals — roughly 16% of the 2,800 in its database — that had not participated in the 2024 or 2025 surveys. Those hospitals were listed as “Grade Not Assigned.” Leapfrog said it “wouldn’t change our methodology for just 5 hospitals” because the Hospital Safety Grade is a national program.16Fierce Healthcare. Leapfrog Group’s Latest Safety Grades Have Far Fewer Low Scores17MedPage Today. Leapfrog’s Hospital Safety Grades Affected by Court Ruling
Removing nonparticipants changed the grade distribution. D grades fell from 224 in the previous cycle to 55. F grades dropped from 22 to five. The spring 2026 report covered 2,363 hospitals, down from 2,813.16Fierce Healthcare. Leapfrog Group’s Latest Safety Grades Have Far Fewer Low Scores18MedPage Today. Grades Affected by Court Ruling Palm Beach Health Network executive Maggie Gill called the drop vindication: “This goes way beyond one lawsuit — there are real consequences to Leapfrog’s misleading grades and pressure tactics.”19Becker’s Hospital Review. Tenet Executive on Leapfrog’s Spring 2026 Grade Gap
Leapfrog’s Response, Appeal, and Fee Fight
CEO Leah Binder issued a statement two days after the ruling calling the injunction a “threat to patient safety” and accusing the judge of prioritizing “the feelings of his local hospitals.” She said the trial focused on a “nuance of Leapfrog’s methodology” unlikely to have changed the hospitals’ final grades. Binder also said Leapfrog “vehemently disagree[s] with this decision, as we believe it threatens the First Amendment rights of every American,” warning that if upheld the ruling could “undermine all published ratings and reviews in all industries.”20The Leapfrog Group. Statement From Leah Binder
Eric Goldman, a professor at Santa Clara University School of Law, said the First Amendment generally protects opinion, including ratings, but noted that Judge Middlebrooks “didn’t address free speech issues raised by the lawsuit,” resting his decision instead on the deceptive practices findings.9Medscape. Judge Orders Rating Group to Delete Grades Leapfrog also pointed out that 406 hospitals that skipped the spring 2025 survey still earned higher grades than the five plaintiffs, which it said cut against the claim that nonparticipation alone drove grades down.21The Leapfrog Group. Follow-Up Statement From Leah Binder
On May 15, 2026, the Palm Beach Health Network moved for $10,499,880.47 in attorney fees under FDUTPA’s fee-shifting provision, roughly $2 million per hospital.22Becker’s Hospital Review. Tenet System Asks Court to Make Leapfrog Pay $10.5M in Legal Fees Leapfrog called the request “unreasonable” and said the hospitals “gratuitously overstaffed” the litigation, asking the court to deny or reduce the award.23Law360. Hospital Rating Group Calls $10.5M Fee Bid Unreasonable The fee decision was deferred as of mid-2026.
On June 17, 2026, Judge Middlebrooks denied Leapfrog’s post-trial challenge, saying none of the organization’s arguments were persuasive.24WUSF. Federal Judge Denies Leapfrog Group’s Appeal25Modern Healthcare. Leapfrog Group Grades Tenet Hospitals Leapfrog says it is complying with the injunction while pursuing further appellate options and reviewing possible methodology changes with its National Expert Panel to bring nonparticipating hospitals back into future releases.26Fierce Healthcare. Leapfrog Group’s Latest Safety Grades
What Comes Next
The appeal will likely turn on the First Amendment question the trial court largely set aside. If an appellate court concludes that Leapfrog’s grades are protected opinion, the ruling could be reversed. If it instead finds that the way Leapfrog generated and marketed those grades crossed into deceptive commercial conduct, the case could reshape how hospital rating organizations operate nationwide.