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Restoring Fairness in Western Pennsylvania

UPMC – a non-profit charity and one of the largest health care insurers + providers in the Commonwealth – is violating Pennsylvania’s charities laws. Their actions are harming patients by creating barriers to treatment and jeopardizing the public interest.

To protect Pennsylvanians, Attorney General Shapiro has taken legal action – seeking to modify the consent decrees with UPMC + its competitor Highmark Health. These changes would protect residents throughout Western Pennsylvania. Highmark agreed to changes – UPMC would not.


Non-profit charities
  • Non-private entities
  • Receive significant public support in the form of tax benefits, tax-free donations
  • Enter into an agreement with the people of Pennsylvania: Further the public good in exchange for tax-exempt status
Consent Decree
  • Formalizes an agreement instead of continuing the case through trial or hearing
  • Any party to a consent decree can request modification
UPMC, Highmark
  • Non-profit charities that pay no taxes
  • Two of the largest health care insurers + providers in Pennsylvania
  • Legally required to promote the public good
Attorney General of Pennsylvania
  • Tasked with enforcing laws that govern charities in Pennsylvania
    • Ensure that institutions who are given public support (in the form of tax breaks and tax-free donations) live up to their mission, comply with the law and act in the public interest

History of the UPMC/Highmark Dispute

  • 2011:

    Highmark becomes UPMC’s competitor in the health care provider market

    UPMC fires back, announces it will stop accepting Highmark-insured patients at the end of their contract

    Highmark and UPMC start battling, forcing many Western Pennsylvanians to lose access to their doctors and care

  • 2014:

    Commonwealth of Pennsylvania intervenes, entering into consent decrees with both UPMC and Highmark to protect access to care

  • 2014-2019:

    UPMC continue battling, violating parts of consent decrees and not living up to their obligations as charities

  • 2019:

    Attorney General Shapiro files petition in Commonweath Court to modify consent decrees and restore fairness to Western Pennsylvania’s health care marketplace

By The Numbers

30% tax-exempt land in Pittsburgh occupied by UPMC
$2.2 billion UPMC-owned tax-exempt property in Pittsburgh and Allegheny County
$40 million Property tax benefits UPMC received from City of Pittsburgh, Allegheny County, and Pittsburgh School District (last year)
$1.27 billion public and private contributions and grants received by UPMC to support its charitable health care, education and research missions (from 2005-2017)

Our Argument

UPMC’s conduct is in violation of Pennsylvania’s charities laws.

As a public charity, which enjoys tax-exempt status, UPMC must behave in a manner consistent with its charitable mission.

UPMC’s actions that run counter to their charitable mission:

  • Requiring out-of-network patients to pay all estimated charges up front and in full before receiving treatment for non-emergency room services (including seniors on Medicare)
  • Refusing to contract with employers who also have contracts with a competing health care provider
  • Refusing to negotiate reasonable payment terms with self-insured employers, resulting in UPMC’s unjust enrichment through excess reimbursements for the value of its services

Our Request

Our petition asks the court to:

Enable Open and Affordable Access to Care

Enable open and affordable access to UPMC’s heath care servcies and products through negotiated contracts with any health plan

Prioritize Compromise

Require last-best-offer arbitration when contract negotiations between insurers and providers fail

Combat Excessive Billing

Ensure against UPMC’s unjust enrichment by prohiibiting excessive and unreasonable billing practices inconsitent with its status as a non-profit charity providing health care to the people of Pennsylvania