Western Pennsylvania’s largest health care company is suing Pennsylvania’s attorney general in U.S. District Court.
UPMC is alleging that a legal action filed by Attorney General Josh Shapiro in Commonwealth Court on Feb. 7 is an “unlawful and unconstitutional” takeover of the nonprofit, making it “impossible for insurance plans to manage their network, forecast costs, and set appropriate rates.”
Shapiro wants to force UPMC to contract with Highmark Health. He argues that for the nonprofit to do otherwise is a failure of UPMC’s charitable mission because it exploits its tax-exempt status in pursuit of commercial success.
“This is a give and take relationship between UPMC and Pennsylvania tax payers, and UPMC is simply taking more than its fair share from Pennsylvanians,” Shapiro said at the press conference announcing his office’s legal action.
Prior to 2012, UPMC was western Pennsylvania’s dominant health care provider and Highmark the region’s biggest insurer. When Highmark ventured into the provider business with its purchase of Allegheny General Hospital, UPMC ramped up its own insurance offerings and stopped accepting Highmark insurance.
This resulted in thousands Highmark insurance customers being cut off from UPMC providers. In 2014, the state interceded, forcing UPMC to accept some Highmark-insured patients – such as children and cancer patients – though this was a temporary solution that is set to expire on June 30 of this year.
Shapiro’s legal action aims to create a scenario where patients can access either health care system, regardless of insurance, by compelling UPMC to contract with any insurance company.
WESA receives funding from UPMC and Highmark.