AG to appeal after judge refuses to extend UPMC-Highmark decree
UPDATE: APRIL 17, 2019: Pennsylvania's Supreme Court has agreed to hear the case against UPMC over its contentious relationship with rival Highmark and whether to extend the expiring consent decree.
- The consent decree between rivals UPMC and Highmark will end as scheduled on June 30, a Pennsylvania judge ruled Wednesday, deferring to an earlier ruling from the state's Supreme Court. The decision is the latest in a legal battle between the state's neighboring health systems.
- Pennsylvania Attorney General Josh Shapiro, who brought the lawsuit seeking to extend the decree so that Highmark members would not lose in-network status at the nonprofit health system, will immediately appeal, a spokesman told Healthcare Dive.
- The judge in this court did not have authority to extend the decree, but he did not say the agreement couldn't be modified at all, the spokesman said. "This enables our office to quickly appeal to the Supreme Court, which we will do in short order given the impending scheduled expiration date," he said.
Shapiro has had fiery language for UPMC, alleging the system has flouted its obligations as a charitable organization and arguing the loss of in-network access would harm healthcare consumers in western Pennsylvania. As part of the lawsuit he filed in February, Shapiro was seeking to modify the terms in the interest of the public.
But Commonwealth Judge Robert Simpson wrote Wednesday he could not go against a superior court's ruling. "Because the OAG does not plead fraud, accident or mistake, this Court lacks the power or authority to modify the termination date of the Consent Decree without the consent of the parties, even if it were in the public interest to do so," he said.
The court declined to rule on the alleged violations of the charities law.
UPMC has filed a counter lawsuit against the attorney general and is also seeking to join a years-long antitrust suit against Blue Cross Blue Shield plans, of which Highmark is one.
In the antitrust case, UPMC wants the courts to stop the Blue Cross Blue Shield plans from enforcing their own market allocation agreements that prevent the health system from contracting with out-of-state Blues plans. The Blues Association has said it's too late for UPMC to join the lawsuit, and the system "cannot manufacture urgency from its own wrongdoing."