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-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
- Formalizes an agreement instead of continuing the case through trial or hearing
- Any party to a consent decree can request modification
- Non-profit charities that pay no taxes
- Two of the largest health care insurers + providers in Pennsylvania
- Legally required to promote the public good
- 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
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
Commonwealth of Pennsylvania intervenes, entering into consent decrees with both UPMC and Highmark to protect access to care
UPMC continue battling, violating parts of consent decrees and not living up to their obligations as charities
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
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 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 planPrioritize Compromise
Require last-best-offer arbitration when contract negotiations between insurers and providers failCombat 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