Pennsylvania’s Top Court Keeps Highmark/UPMC Dispute Alive

May 28, 2019

The state Supreme Court Tuesday kept alive hopes that people with Highmark insurance can continue using UPMC doctors, finding that a provision in a five-year consent decree was too ambiguous to make a definitive ruling.

On Tuesday, the state Supreme Court, in a 4-3 decision, ordered the Commonwealth Court to gather more evidence on what UPMC, Highmark and the Office of the Pennsylvania Attorney General originally intended the clause to say. The high court said the hearing in Commonwealth Court must happen before the decree’s expiration date, June 30.

Attorney General Josh Shapiro kicked off the legal action back February in an attempt to continue the decree so as to allow people with Highmark insurance to keep seeing UPMC providers at in-network rates. He argued a modification provision allows for an extension, while UPMC contends that provision was only for minor changes.

Writing for the majority, Justice Daivd Wecht said that the modification provision is, “subject to more than one reasonable interpretation.” And that, “Although the applicable termination date is near, the dispositive legal question is narrow and evidentiary record that is necessary to resolve that question accordingly will be limited.”

In his dissent, Justice Max Baer said that modification sought by the attorney general is not a modification at all, “But, rather, an attempt to seek judicial intervention to eliminate the termination date and improve upon UPMC a permanent injunction requiring that it remain tethered to Highmark indefinitely.”

Despite the court giving no conclusive answer on the decree’s future, both UPMC and the attorney general’s office claimed victory in the ruling.

“Today, the Pennsylvania Supreme Court took a crucial step towards delivering justice for the people of Western Pennsylvania by agreeing with my Office’s argument and reversing Commonwealth Court’s decision that the end date of UPMC/Highmark’s consent decrees could not be modified as a matter of law,” said Shapiro, referring to the Commonwealth Court’s earlier decision. 

Meanwhile Paul Wood, UPMC’s chief communications officer, pointed out that the court hadn’t agreed with Shapiro’s argument that the provision allows for changes to the decree that are as significant as extending the expiration date.

“None of the justices, notably, accepted the OAG’s position that the modification clause was unlimited, deciding this issue was a matter for Commonwealth Court to resolve after receiving additional evidence,” said Wood. “Importantly, all the justices agreed that it was not necessary for them to extend the termination date of the Consent Decrees through their extraordinary powers.”

However the Commonwealth Court rules, it’s an almost certainty that decision will be appealed.