UPMC alleges AG Shapiro is promoting the interests of Highmark, not the public

Pennsylvania Attorney General Josh Shapiro is promoting the private interests of Highmark Health over the public good in his attempt to force UPMC to contract with its rival, UPMC told a state court Monday.

UPMC made the argument in Commonwealth Court as part of its opposition to Shapiro’s petition to force changes upon UPMC and rewrite a 2014 consent decree between UPMC and Highmark, two longtime feuding, Pittsburgh-based health care giants that control both insurer and provider arms.

UPMC’s filing contends that there is no legal basis for Shapiro’s “unprecedented and extreme interpretation” of the 2014 consent decree nor does he have the ability to alter it.

Further, UPMC argues that Shapiro’s proposed changes would permit Highmark to steer patients away from UPMC and “also exclude UPMC entirely when it suits Highmark’s needs.”

“By arming Highmark with these exclusionary tools, the Attorney General would nullify the very interest he is purportedly seeking to promote: affordable, in-network access to UPMC through compelled contracts,” the filing states.

The state-brokered consent decree between UPMC and Highmark expires June 30. Highmark-insured patients will become out-of-network at most UPMC hospitals on July 1. UPMC plans to enforce a new rule that requires out-of-network patients to obtain a cost estimate and prepay, in full, for all non-emergency services before receiving treatment.

“Now, on the eve of the expiration of that five-year consent decree, General Shapiro wants to change the rules and say that this orderly wind-down, all along, violated Pennsylvania law,” the filing states.

Shapiro has said he is not intimidated by UPMC’s legal arguments.

“My team and I look forward to making our case in court to protect access to affordable health care in Western Pennsylvania,” Shapiro said Friday.

Soon after the consent decree was signed in 2014, Highmark rolled out new Medicare Advantage plans that excluded in-network access to UPMC, and Blue Cross/Blue Shield plans have refused to contract with UPMC.

UPMC says, when Highmark acquired the Allegheny Health Network hospital system, it indicated that it intended to use it share of the insurance market to move more than 41,000 patients annually from UPMC hospitals into Highmark’s hospital system.

“Yet, the Attorney General has turned a blind eye to this, doubling down on his model of exclusion and making a mockery of the very public interest he purports to support,” the filing says.

The filing also said that, even if the court were to grant Shapiro’s petition, “there is no indication that increased in-network access will follow.”

“The Court should demand more than his ‘say so’ before allowing a claim to proceed,” UPMC wrote.

Shapiro announced Feb. 7 that he was filing a petition to modify the UPMC-Highmark consent decree.

Among other demands, Shapiro asked UPMC hospitals and doctors to accept Highmark patients “in perpetuity” and drop the controversial prepay rule threatening to impact thousands of Highmark-insured Medicare Advantage patients and cancer patients when it takes effect in July.

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