Commonwealth of Pennsylvania v. UPMC et al.Date Filed: February 7, 2019
District Court: Commonwealth Court of Pennsylvania – No. 334 M.D. 2014
Nature of Suit: Antitrust
Defendant Type: Provider, Payer
Plaintiff Type: State
Case Info: https://www.attorneygeneral.gov/upmc/
Court Document: https://www.attorneygeneral.gov/wp-content/uploads/2019/02/UPMC-filing.pdf|http://src.bna.com/FQ0
In February 2019, Pennsylvania Attorney General Josh Shapiro stepped in to intervene in the long-standing battle over market share between University of Pittsburgh Medical Center (UPMC) and Highmark Health. The AG filed a court petition to require UPMC to open its provider network and fairly negotiate with Highmark Health and other health plans. The legal action alleges that as a nonprofit charity, UPMC’s anticompetitive behavior has violated its charitable obligations to act in the public interest by charging patients insured by competitors high out-of-network rates for access to UPMC’s hospitals and physicians.
This all began in 2011, when Highmark acquired West Penn Allegheny Health System to compete directly with UPMC, which also operates a health plan in the western Pennsylvania region. The spat eventually drove both integrated systems to exclude one another’s facilities from each other’s networks. In 2014, the state issued a consent decree to ensure coverage and affordable, in-network access for patients. Five years later, with the decree expiring on June 30, the same issues are resurfacing. The AG alleges that despite the consent decree, UPMC failed to limit amounts charged to Highmark subscribers, denied treatment to out-of-network patients, and refused to contract with Highmark and other health plans. Furthermore, the lawsuit alleges that UPMC’s anticompetitive behavior has extended beyond the western Pennsylvania market to the eastern part of the state, where the health plan withheld access to its doctors for patients insured by competing health plans. Read more on The Source Blog or visit the Pennsylvania AG website.
UPMC fought back with a motion to dismiss and a countersuit, alleging the AG unlawfully meddled in federal healthcare programs, in violation of four federal laws. See The Source Blog for more info.