UPMC to cut ties with Highmark after court ruling

Pennsylvania Commonwealth Court ruled on Friday that Pittsburgh-based UPMC can stop accepting Highmark Health-insured patients by the end of the month.

The ruling is part of an ongoing argument over the end date of a consent decree between the Office of the Attorney General, UPMC and Highmark Health.

Attorney General Josh Shapiro took UPMC to court this week in the hopes of extending the terms of a 2014 consent decree. The decree gave the systems a five-year transitionary period leading up to June 30, 2019 at which point UPMC would stop accepting patients insured by Highmark.

The state’s Commonwealth Court sided with UPMC, meaning that the health system can finish its transition away from its former partnership with Highmark and its providers will stop accepting the insurer on June 30.

Shapiro said that the split would harm the many Pennsylvanians insured through Highmark that rely on UPMC for their health care.

“Make no mistake, our work here is not done,” Shapiro said in a statement Friday. “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.”

Shapiro and his office argued that a provision in the decree allowed for changes in the contract that could be used to rewrite the end date to continue indefinitely.

Commonwealth Court had ruled in April that the consent decree could expire as scheduled on June 30. The Office of the Attorney General appealed the court’s decision, arguing that the decree should be extended because of the modification provision.

Late last month the appeal was heard by the Pennsylvania Supreme Court, which ruled 4-3 in favor of Shapiro, allowing the case to be heard once again in Commonwealth Court. In the Supreme Court’s majority opinion of the case, Justice David Wecht wrote that the Attorney General had the right to have the case heard again in Commonwealth Court, utilizing the modification provision as evidence.

“Given the unbounded language of the Modification Provision, seasoned counsel likely foresaw, or should have foreseen, the possibility that significant alterations might be requested,” Wecht wrote.

Judge Robert Simpson of state Commonwealth Court did not agree with the Supreme Court’s decision and instead claimed that given UPMC’s consistent attempts to try to end its partnership with Highmark, there was no reason to believe that UPMC would have agreed to something that could have made the relationship indefinite.

“The general provision does not include any express limitation; nevertheless, there is no believable evidence that any party intended the general modification provision to override the specific termination/expiration provision which had been the subject of negotiations almost from the beginning,” Simpson wrote.

UPMC released its own statement regarding the ruling, noting that the system was pleased with the court’s decision.

“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,” the system wrote.

Shapiro could still appeal the court’s ruling in the Pennsylvania Supreme Court and said in his statement that his office will be announcing subsequent legal steps next week.