Pennsylvania AG accuses UPMC of violating charity laws
© WikiMedia (Doug Kerr)

Pennsylvania AG accuses UPMC of violating charity laws

Pennsylvania Attorney General Josh Shapiro announced Thursday that his office filed a petition to modify the current consent decrees between University of Pittsburgh Medical Center (UPMC) and Highmark Health (Highmark) to include requirements that ensure UPMC will promote public interest in the state. Specifically, Shapiro’s petition requests that UPMC is held accountable to their obligations as a public charity.

The petition argues that UPMC is unjustly enriched as a result of their excessive reimbursements and failure to discuss affordable options for self-insured employers. Additionally, UPMC is accused of preventing patients with competing health plans from seeing UPMC participating providers. All actions, Shapiro claims, are in violation of UPMC’s status as a public charity for the benefit of the people of Pennsylvania. The petition seeks to rectify this public harm by extending and modifying the current consent decrees in place.

The current consent decrees were created in 2014 by the Commonwealth Court after UPMC and Highmark’s competition continued to grow. UPMC and Highmark are the two largest health plan providers within Pennsylvania. To prevent insurance prices from rising and general harm to the public, the court set out an agreement of how UPMC and Highmark were to interact with one another. One such stipulation allowed members of either insurance to use facilities from the other. The consent decrees are set to expire on June 30, 2019.

Due to the impending expiration, modifications of the consent decrees were proposed by Pennsylvania’s Office of Attorney General. In their proposal, the consent decrees would bring UPMC and Highmark up to compliance with their charitable obligations. While Highmark agreed, UPMC did not and the subsequent legal action was taken.

The proposed consent decrees aim to prohibit UPMC’s unjust enrichment by preventing unreasonable billing practices and require best-offer arbitration. Additionally, the petition would further require UPMC to enter into contracts with other health plans to ensure open and affordable access to UPMC facilities and services.

By enacting these modifications into a new consent decree between Highmark and UPMC, Pennsylvania’s Office of Attorney General claims the public will be protected from harm.