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Judge Rules He Can't Extend Consent Decree Between UPMC, Highmark

Pennsylvania Attorney General Josh Shapiro, center, speaks at a news conference about legal action in the dispute between health insurance providers UPMC and Highmark Health, Thursday, Feb. 7, 2019, in Pittsburgh.

The Commonwealth Court has ruled that it cannot extend the consent decreebetween UPMC and Highmark.  

“Our Supreme Court has already decided that the June 30, 2019 termination date is an unambiguous and material term of the Consent Decree,” wrote Judge Robert Simpson in his opinion.

Simpson went on to say that he lacks the authority to modify the termination date, “even if it were in the public interest to do so.”

The decree, created in 2014, mandates that certain patients with Highmark insurance continue receiving in-network care from UPMC health providers. State attorney general Josh Shapiro wants it extended indefinitely.

“As a public charity, especially one enjoying perpetual tax-exempt status, UPMC must behave in a manner consistent with its charitable mission in all facets of its operation,” said Shapiro when he filed the legal action, back in February. “UPMC is taking more than its fair share from taxpayers.”

Shapiro is targeting UPMC because it rejected modifications to the consent decree that Highmark had agreed to.

UPMC’s chief communication officer Paul Wood said that “UPMC agrees” with Simpson’s ruling.

A spokesperson for Highmark insurance said, “We continue to support the attorney general’s efforts because it’s in the best interest of the community.”

In a written statement, a spokesperson for the attorney general said Simpson’s ruling, “This enables our Office to quickly appeal to the Supreme Court, which we will do in short order given the impending scheduled expiration date.”

The judge did rule in Shapiro’s favor over several other arguments that UPMC had also raised. This includes the attorney general’s authority to regulate public charities and compel UPMC to contract with Highmark.

“The responsibility of supervising charitable trusts has traditionally been delegated to [the office of the attorney general,” wrote Simpson. “Property given to a charity is in a measure public property, and the beneficiary of charitable trusts is the general public to whom the social and economic benefits of the trusts accrue.”

However, it’s the attorney general, not UPMC, that bears the burden of proving that the hospital system is abusing its status as a charitable nonprofit.

Sarah Boden covers health and science for 90.5 WESA. Before coming to Pittsburgh in November 2017, she was a reporter for Iowa Public Radio. As a contributor to the NPR-Kaiser Health News Member Station Reporting Project on Health Care in the States, Sarah's print and audio reporting frequently appears on NPR and KFF Health News.