Judge Rules That UPMC-Highmark Consent Decree Can Expire June 30

Jun 14, 2019

Most UPMC patients with Highmark insurance will lose in-network access to the medical system's doctors and facilities at the end of this month, a Commonwealth Court judge ruled on Friday. 

Under a five-year consent decree, UPMC was obliged to provide access to Highmark customers through June 30, 2019. But Attorney General Josh Shapiro sought to have the consent decree governing the relationship between the two health care systems extended beyond June 30, while his office makes the case that UPMC should accept coverage from all insurers indefinitely.

Judge Robert Simpson ruled in favor of UPMC Friday, after hearing arguments earlier this week. 

“UPMC is pleased” that the consent decree will end “as intended and anticipated by all,” wrote Vice President of Communications Paul Wood in an e-mailed statement. “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 question before Judge Simpson was whether UPMC had agreed to a clause that would allow for the consent decree to be extended. UPMC said it had not, and that the “modification clause” at issue was meant to fix small errors in the agreement, not extend it wholesale. Lawyers from Shapiro’s office argued that the clause did allow for the extension of the consent decree.

The ruling does not resolve the dispute between Pennsylvania’s largest private employer and its attorney general, however. Shapiro alleges that UPMC is abusing its tax-exempt status by refusing to accept Highmark insurance in most cases.

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

In the statement, Shapiro said he'd announce future moves next week. Observers expected that no matter how Simpson ruled, there would likely be an appeal to the state Supreme Court.

Highmark also weighed in with a statement, saying “This ruling is not a defeat in preserving health care choice for consumers, but rather just a temporary setback.”

Even if the decree does expire, UPMC has said it will continue to accept Highmark insurance customers at Hillman Cancer Center, Children’s Hospital of Pittsburgh and Western Psychiatric Hospital. Highmark said it has not received a detailed contract proposal from UPMC regarding in-network access at Hillman.

This is a developing story.

WESA receives funding from Highmark and UPMC.