Attorney General Josh Shapiro accused UPMC on Thursday of violating its obligation as a public charity and asked a state court to intervene in its breakup with rival Highmark by forcing it to accept out-of-network patients at affordable rates.
In a 73-page legal challenge filed in Commonwealth Court, Shapiro accused UPMC of breach of fiduciary duties and violating the Solicitation of Funds for Charitable Purposes Act and Unfair Trade Practices and Consumer Protection Law. The petition is posted on the attorney general’s website.
Shapiro is seeking a court-ordered modification of a 2014 state-brokered consent decree that would require UPMC to accept Highmark and any other out-of-network patient in perpetuity.
”The consent decree modifications would do three things: first, require UPMC and Highmark to work together; second, ensure fairness for Pennsylvania taxpayers; and third, protect access for all patients,” Shapiro said during a news conference. “This is not about my office inserting itself into the health care market. We do not want to interfere with the important relationship between doctors and patients.
“We want to stop UPMC from unlawfully interfering with that relationship.”
He said open access to UPMC should be made through “negotiated contracts with any health plan.”
Stephen Foreman, a Robert Morris University associate professor of health care administration and economics, said Commonwealth Court would likely have to act on Shapiro’s complaint.
“I think it would be hard to duck it,” Foreman said, adding that he believes the case will eventually end up before the Pennsylvania Supreme Court. “I think that what constitutes a public charity is in some ways pretty amorphous. I’d like to see the court better define the kinds of conduct that constitute charitable conduct.
”I think what UPMC is doing with out-of-network Highmark people by making them pay in advance is not charitable.”
UPMC contends that competition is beneficial to consumers.
“The five-year transition as provided for by the consent decrees expiring June 30, 2019, has allowed businesses and consumers substantial time to prepare for the end of the UPMC-Highmark relationship in Western Pennsylvania,” UPMC spokesman Paul Wood wrote in an emailed statement. “During that period, the region’s insurance marketplace transformed from one of the nation’s most highly concentrated and least competitive to one of the most competitive and pro-consumer markets in the nation with some of the lowest cost health plans available anywhere.”
The two nonprofits have clashed over contracts despite the 2014 consent decree aimed at addressing their feud. The consent decree expires June 30, which means thousands of people with Highmark insurance will not have in-network access to many UPMC hospitals and doctors.
Shapiro announced the court filing during a news conference in his Strip District offices. He was accompanied by about 20 residents who fear they will lose access to UPMC doctors after the June 30 deadline. He was joined by Lt. Gov. John Fetterman of Braddock, who pledged full support from his office and the governor’s. Fetterman, the former Braddock mayor, battled with UPMC over the 2010 closing of Braddock Hospital.
Brittany Eckert, 32, of East Deer said she chose UPMC doctors because they were the only ones she found with experience in treating her rare form of uterine cancer.
“Come June of this year, I have to start my search and my journey all over again because, having Highmark insurance through my husband’s work, I will no longer be able to see my UPMC oncologist, who saved my life from a death sentence,” she said. “It’s very stressful and a very scary process.”
Shapiro said his office proposed “common sense” modifications of the consent decree to UPMC and Highmark.
“I’m here today to announce that Highmark has agreed to those modifications,” he said. “I’m also here today to announce that UPMC did not. UPMC could still change its mind. They could still do the right thing and agree to these modifications, but until then I have no choice but to act to protect Pennsylvanians. I can’t sit idly by and watch our seniors and children and workers suffer because of corporate greed.”
David Holmberg, president and CEO, Highmark Health, said in a conference call with reporters that Highmark is “fully committed” to working with Shapiro’s office.
“We said that getting health care right would be our focus, and that’s exactly what we’ve done as an organization,” he said. “We are very confident that, in a totally competitive market where everybody has to play by the same rules, we will provide a unique experience and a winning formula.”
Highmark officials last year asked UPMC to reconsider its plan to require Highmark-insured Medicare Advantage patients to prepay their nonemergency medical bills in full if they want to continue using UPMC facilities and doctors next summer.
The prepay requirement — announced along with the release of 2019 Medicare plan rates nationwide — is set to take effect June 30.
“As for Medicare Advantage, a federally regulated program, seniors now have more options and enjoy the benefits increased competition provides in terms of low pricing and more expansive plan design,” Wood said. “To the extent there remains any confusion, seniors with Medicare Advantage plans have another opportunity, from January 1 through March 31, to clarify their options and switch their coverage so they have the in-network access to the providers they prefer.”
Bob Bauder is a Tribune-Review staff writer. You can contact Bob at 412-765-2312, email@example.com or via Twitter @bobbauder.