Top Stories

NO EXTENSION: Judge says the deal between UPMC and Highmark can't be extended

HARRISBURG, Pa. — A Pennsylvania judge says a 5-year-old agreement involving two Pittsburgh-based health care conglomerates can't be extended through litigation past its June 30 expiration date.

Commonwealth Court Judge Robert Simpson said in a decision issued Friday that a modification clause in the 2014 consent decree involving UPMC and Highmark can't be used to get around the deal's explicit end date.

Download the WPXI News App to receive breaking news alerts on this story. CLICK HERE to find out how.

Simpson was directed to consider the issue by the state Supreme Court, and it's likely the justices will have the final say.

The end of the consent decree is expected to trigger higher costs for Highmark insurance customers who use UPMC's vast network.

Highmark and the attorney general's office want to extend the agreement, while UPMC is opposed.

A UPMC spokesperson sent the following statement:

"UPMC is pleased with today's Commonwealth Court ruling that the Consent Decree entered into by UPMC with the Office of the Attorney General, Pennsylvania Insurance Department and Department of Health should terminate, as intended and anticipated by all, on June 30, 2019. UPMC is grateful the Commonwealth Court expeditiously reached this decision. We look forward to continuing to fulfill our long-standing charitable mission and serving the public with UPMC's world-class physicians and facilities."

A Highmark spokesperson said the following:

"Today's Commonwealth Court ruling prohibits the extension of the current Consent Decree governing the relationship between Highmark and UPMC beyond June 30, 2019. The ruling concluded that the extension proposed by the Pennsylvania Attorney General exceed what was intended by the modification provision in the Consent Decree. 
This ruling is not a defeat in preserving health care choice for consumers, but rather just a temporary setback. Attorney General Josh Shapiro continues to maintain his strong commitment to ensuring accessible affordable health care for all and to precluding UPMC from continuing its denial of access to the whole community. The Attorney General has several options for going forward, including appealing the Commonwealth Court's ruling to the Pennsylvania Supreme Court or returning to the Commonwealth Court to pursue the three remaining counts against UPMC in his petition, which focuses on protecting patients and health care consumers and allege that UPMC violated its nonprofit, charitable mission.  In counts two, three and four of the lawsuit, the Attorney General alleges that UPMC has violated the Solicitation of Funds for Charitable Purposes Act, breached its fiduciary duties owed to the public under the Nonprofit Corporation Law, and violated consumer protection laws.
At Highmark Health, we have long held to the truths that vital community assets must be available for the public good and that nonprofit and charitable organizations exist for the benefit of the community. We fully agree with the principle of preserving health care choice for all consumers; the sustainability of tiered, high-performance network health plans to meet consumer demand for quality, affordable care; and ensuring health care competition. We have always been, and will remain, willing to support ideas to address heath care that is accessible to all.
Highmark Health remains fully committed to the execution of our strategy at the Allegheny Health Network (AHN).  Today's action does not change our strategic focus of ongoing, planned investments in AHN and our overall path forward. We are staying the course to provide more health care choices in the community and build a more effective and affordable community-based health care network. Many of the major new facility investments that we have announced over the past 18 months will become operational this year, or shortly thereafter. And we continue to explore ways in which we can further enhance the quality and availability of our services in the community.  
We've always believed that a level playing field should exist among health insurance companies and health care providers. We believe that all health plans and health systems should compete based on their value to the consumer.
In the meantime, in regards to UPMC's recent public statements about the elimination of pre-pay and access to Hillman Cancer Center, we have not received a detailed contract proposal on these issues directly from UPMC – nor has the Attorney General. To protect our health plan members and patients, we need to secure contract language and agreements so that UPMC's practices align with their verbal commitments. We look forward to working with the Attorney General and UPMC, if UPMC is willing to work in good faith."


Pennsylvania Attorney General Josh Shapiro said:

"Make no mistake—our work here is not done. While we are disappointed in Judge Simpson's ruling, I won't quit on the people of Western Pennsylvania and we will continue to take steps to restore fairness to the healthcare system and give people access to the institutions their tax dollars built. We will announce subsequent legal steps next week."

State Rep. Dan Frankel (D) Allegheny also sent a statement that said, in part:

"It is now crystal clear that if we want institutions like UPMC to do the right thing, the laws need to change. While this case makes its way through the courts, I implore my colleagues to pass my bipartisan legislation to require charity hospital-insurance company hybrids to behave in the public interest and stop the predatory business practices."

The Associated Press contributed to this report.