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Analysis

Unconstitutional Interference? UPMC Countersues Pennsylvania AG

By Steven Porter  
   February 22, 2019

A long-running feud between UPMC and Highmark is heating up as the expiration date on a five-year consent decree draws near.

Two weeks after Pennsylvania Attorney General Josh Shapiro announced a lawsuit accusing the University of Pittsburgh Medical Center (UPMC) of neglecting its charitable obligations, the nonprofit countersued on Thursday, claiming the state's top law enforcement official lacks the legal authority to meddle in UPMC's negotiations with Highmark and other health plans.

Shapiro asked a state court to modify a five-year consent decree that govern UPMC's dealings with Highmark and which are set to expire this summer. His actions are needed "to restore fairness to the healthcare system" in the region, he said. But UPMC's countersuit alleges that Shapiro has crossed not only a legal line but also a constitutional one.

"Without rulemaking, legislation or public comment, ... Shapiro has announced new 'principles' that radically (and often in direct contravention of existing federal and state law) change how nonprofit health insurers and providers operate, now rendering the Attorney General the arbiter of how nonprofit health organizations should envision and achieve their mission," the UPMC complaint states. 

Related: Pennsylvania AG Accuses UPMC of Ignoring Charity Obligations

Related: How UPMC Turned Innovation Into Enterprise

Related: Highmark Health's CEO Talks 'Miracle' Drugs, 'Superpower' Data

The UPMC-Highmark feud has been long-running, as the payer-provider organizations have jockeyed for market dominance in western Pennsylvania. State officials required the two to work together, imposing a consent decree in 2014 that required each health plan to cover services provided by the other organization. That decree is set to expire June 30.

In a separate filing on Friday, UPMC asked a federal judge to issue a preliminary injunction to prevent Shapiro from proceeding with his efforts.

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.


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