Shapiro asks Pa.’s top court to rule on UPMC/Highmark consent decree

Dawn Ouellette Nixon, BridgeTower Media//April 11, 2019

Shapiro asks Pa.’s top court to rule on UPMC/Highmark consent decree

Dawn Ouellette Nixon, BridgeTower Media//April 11, 2019

After losing a round in Commonwealth Court, Pennsylvania Attorney General Josh Shapiro is appealing to the Pennsylvania Supreme Court over his bid to extend a consent decree governing the relationship between UPMC and Highmark.

Shapiro is seeking to extend the decree, which is set to expire this summer. Originally set in place in 2014, the decree ensures that people with Highmark insurance can get in-network access to UPMC providers.

The dispute began after Highmark established its own network of hospitals, Allegheny Health Network, in 2013, prompting UPMC to terminate contracts with Highmark, which had become a competing provider.

The Commonwealth Court ruled April 3 that the consent decree could expire as scheduled on June 30. Shapiro filed an appeal April 8 asking that the decree be extended.

The decrees ensure that UPMC abides by its charitable obligations as a nonprofit, and allows patients access to affordable health care and facilities, according to Shapiro. This access must include allowing Highmark members in-network access to UPMC.

“Despite its charitable mission, UPMC is spending exorbitant sums of money and countless hours on legal tactics aimed at preventing people from receiving care,” Shapiro said in a statement.

Efforts to reach UPMC were not successful. But it has previously challenged Shapiro for attempting to rewrite the rules governing nonprofit hospitals.

Aaron Billger, vice president of communications for Pittsburgh-based Highmark, said the case could determine the future of health care and the definition of a nonprofit in Pennsylvania.

“This could be groundbreaking,” Billger said. “The attorney general has taken this action independently of us. We want what is in the best interest of the community. We believe the community deserves a choice in health care providers. Highmark has always desired a relationship with UPMC.”

Highmark operates health insurance plans in Pennsylvania, Delaware and West Virginia, in addition to operating the Allegheny Health Network.

Highmark expects a decision from the court in May.

In a separate federal lawsuit, the trade association for Pennsylvania hospitals is seeking to block the attorney general’s suit from moving forward. The Hospital & Healthsystem Association of Pennsylvania contends that Shapiro’s arguments, if they prevail, could eventually force providers to do business with any insurer, regardless of the terms.