Judge to decide next week if AG Shapiro can block looming UPMC-Highmark split | TribLIVE.com

Judge to decide next week if AG Shapiro can block looming UPMC-Highmark split

Natasha Lindstrom
Erin Ninehouser (left), spokeswoman for the Pennsylvania Health Access Network advocacy group, and Vicki Arnett (center), whose husband is a cancer patient from Western Pennsylvania, and Allegheny County Controller Chelsa Wagner (second from right) were among several speakers during a May 14, 2019 rally in Harrisburg calling for urgent legislative intervention in the looming UPMC-Highmark divorce. Arnett’s husband is traveling to Atlanta for cancer treatments because as of July 1 his Highmark insurance will be considered out-of-network at most UPMC facilities, including the Hillman Cancer Center.

Western Pennsylvanians should know by next Friday whether Pennsylvania Attorney General Josh Shapiro’s legal fight to block the June 30 split of health care giants UPMC and Highmark can go on.

After last week’s split decision by the state Supreme Court, UPMC and Shapiro’s legal teams next are scheduled to face off during a two-day trial in Commonwealth Court in Harrisburg.

The non-jury trial, or evidentiary hearing, is set to begin 9:30 a.m. Monday, June 10 at the Pennsylvania Judicial Center and continue at 9:30 a.m. Tuesday, Commonwealth Court Judge Robert E. Simpson wrote in an order filed Monday.

Simpson plans to issue his ruling two days after the trial, by Friday, June 14, he wrote in the June 3 order.

Shapiro, whose attorneys will make their case on the first day of the trial, seeks to convince the court to allow for a delay or indefinite extension of the expiration of a 2014 state-brokered agreement between UPMC and Highmark, Downtown-Pittsburgh based nonprofit behemoths that each control both provider and insurer arms.

The consent decree was supposed to ease the transition for consumers after the competing systems refused to agree on in-network patient contracts beyond this summer. The rivals since have clashed over its terms and, last fall, UPMC announced a controversial prepay rule for out-of-network patients that is set to take effect in July.

Shapiro says a general modification provision folded into the decree allows him to seek the extension.

The Supreme Court decided in a split opinion that Commonwealth Court has the authority and capability of deciding the modification issue. The high court called on Simpson to hold an expedited evidentiary hearing.

RELATED: Supreme Court sends legal fight over UPMC-Highmark split back to lower court

UPMC contends that the June 30 expiration date of the consent decree it inked with Highmark five years ago cannot be changed and says UPMC executives never would have signed the agreement had they known it ever could. UPMC further argues that Shapiro is overstepping his bounds in a politically charged quest to reshape health care and siding with Highmark’s interests over the public good.

Highmark’s representatives could join Shapiro’s team in making arguments on the first day of the trial, though UPMC has filed a motion to block Highmark from participating.

UPMC’s attorneys will present their case on the second day of the nonjury trial. All parties must submit their proposed fact findings and legal conclusions by noon June 13.

The clock is ticking for Shapiro to secure the court intervention he’ll need to advance his broader case against UPMC.

Among other demands, Shapiro asked in a Feb. 7 legal petition that UPMC hospitals and doctors accept Highmark patients and patients from any willing insurers “in perpetuity” and drop the out-of-network prepay rule. He’s attempting to alter the terms of the consent decree as a vehicle to force changes upon UPMC.

As the consent decree stands, UPMC and Highmark will officially split insurance networks for thousands of Medicare Advantage and cancer patients on June 30. A controversial prepay-in-full rule for out-of-network patients seeking nonemergency care at most UPMC hospitals is set to take effect July 1.

The prepay rule spurred confusion and outrage when UPMC announced it on Oct. 1, and Highmark immediately asked UPMC to reconsider.

Attorneys for UPMC argued in previous court filings that UPMC never would have imposed such a drastic measure had it not been for Highmark’s purported history of failing to pay or underpaying its bills and slashing its reimbursement rates — all while aggressively working to steer Western Pennsylvanians away from UPMC doctors and hospitals.

Both UPMC and the Attorney General’s Office must file a list of witnesses and summaries of their anticipated testimony in Commonwealth Court by 11 a.m. Thursday.

RELATED: UPMC, Attorney General’s legal teams face off before Pa. Supreme Court

Natasha Lindstrom is a Tribune-Review staff writer. You can contact Natasha at 412-380-8514, [email protected] or via Twitter .

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