Skip to comments.Attorney general announces legal action in UPMC-Highmark dispute (Pittsburgh, PA)
Posted on 02/07/2019 12:55:06 PM PST by Buckeye McFrog
Attorney general announces legal action in UPMC-Highmark dispute
PITTSBURGH - Pennsylvania Attorney General Josh Shapiro filed a petition to stop UPMC and Highmark from a complete separation which was set to happen this summer.
#BREAKING: Shapiro says court order would ensure that UPMC abides by its charitable contribution obligations to Pennsylvania
Given the effect this dispute between UPMC and Highmark is having on Pennsylvanians, and the imminent expiration of the existing consent decree, we are asking the court to take action, said Shapiro. These changes are absolutely necessary to prevent UPMC from inflicting further harm on the public by forsaking its charitable obligations in pursuit of commercial success.
The petition, which was filed in Commonwealth Court, seeks a modification of consent decrees that govern the relationship between the two healthcare giants. The petition asks the court to: Enable open and affordable access to UPMCs health care services and products through negotiated contracts with any health plan Require last, best-offer arbitration when contract negotiations between insurers and providers fail Protect against UPMCs unjust enrichment by prohibiting excessive and unreasonable billing practices inconsistent with its status as a non-profit charity providing healthcare to the public
#BREAKING: @PAAttorneyGen says As a public charity...enjoying perpetual tax-exempt status...UPMC is taking more than its fair share from taxpayers
In 2014, the state intervened in the dispute between UPMC and Highmark, issued consent decrees with both organizations. Those decrees govern how the two companies must interact to protect further harm to the public, according to a release by the attorney generals office. Shapiro said Highmark agreed to the modifications but UPMC did not, leading to legal action
#BREAKING: @PAAttorneyGen says Highmark has agreed to modifications and UPMC has not. Shapiro says he must file this court order to stop corporate greed.
UPMC has become pretty much a healthcare monopoly here in Pittsburgh, snapping up most of the local hospitals and medical practices. They also sell health insurance. Highmark is their biggest local competitor in the health insurance space.
UPMC has been threatening to end its relationship with Highmark and effectively bar anyone holding Highmark insurance from being treated by UPMC doctors or facilities. This has resulted in a mad game of musical chairs as people are told they can no longer see their doctors and they must find new ones.
This has created angst, anger and outrage here in Pennsyltucky, and resulting demands that the government step-in and DO SOMETHING.
Well, it appears that they are about to DO SOMETHING.
Pennsylvania's Democrat Attorney General is going to court to FORCE these two to play nice together. Things that strike me from this story:
- The State is very concerned that UPMC continue with coerced "charitable contributions".
- The State is very concerned that UPMC is "taking more than its fair share" from taxpayers.
- The State AG feels it is his duty and prerogative to "stop corporate greed".
- The courts may in fact agree with all of the above and take action.
The AG is reacting to petitions and angry calls to Harrisburg about this situation. It all tells me that we are getting pretty close to the point where people are just going to throw their hands up and tell the government to take it all rather than continue to expend stress and anger over butthead organizations like UPMC and Highmark.
Just a wild guess, but is it run by Rats?
That’s a great on-the-ground view of what’s going on. Thanks.
All I knew before, from a distance, was that UPMC was a big and respected medical hospital and university in Pittsburgh.
UPMC has been buying up hospitals and medical practices in this area since the 80’s. I don’t know what % they now hold, but if you told me 75% I would not be shocked. Why they were allowed to amass a monopoly is another question for our AG. But it has real repercussions in that if your insurance plan does not play nice with UPMC you will have a hard time finding treatment here. (I know a guy whose wife has MS. He is in this very same boat.)
Needed: an antitrust remedy against UPMC, and competition with Highmark from out-of-state providers. May require federal enforcement and legislstion. Futile to try to regulate these two behemoths into cooperating with each other.
Glad I have Geisinger Gold Preferred; I almost went with Highmark 10 years ago. With almost $1mm in medical bills over the past 18mos, Medicare and Geisinger have picked-up all but $6,500.
A defacto stranglehold on health care is bad enough.
What’s the other side of the deal mentioned in the article about? That they are charitably favored by the State, and that that might be at stake? I thought UP was a private university, unlike, say Penn State.
Pitt, along with Temple, are “state related” universities.
Ostensibly private, but the Commonwealth started kicking in a big chunk of their operating budgets back in the early 70’s, supposedly to keep tuition down (yeah, how did THAT work out?)
Thus we get the worst of both worlds....states that suckle at the public teat, yet are not under direct control like Penn State or the state university system.
UPMC at this point has almost nothing to do with the university from which it got its name.
ofc more “direct control” of Penn State hasn’t worked out so well, either.... big scandals from Sandusky diddling charity boys to Michael Mann using Penn State’s auspices to promote his climate frauds....
for anyone wondering, UPMC = “University of Pittsburgh Medical Center”
May seem obvious but it was surprising difficult to find the words spelled out to confirm this just now.....
With UPMC buying Williamsport and Sunbury hospitals it is tightening the noose around Geisinger. They already prohibit critical cases from being transferred to GMC, instead they must go to UPMC hospitals farther away.
Pinnacle Health and UPMC are both tightening their nooses around my medical destinations: WellSpan Health, York Hospital, PSU-Hershey Hospital, too. Hershey’s on a major building program to double the size of that already massive campus, but it has huge PSU money and medical school behind it, so UPMC is going to get its ass kicked if it tried to infringe.
This story is repeated over and over all across the fruited plain.
The People are sick to death of it. The major competitors have rigged the game. The private sector (except for boob jobs and LASIK) died a long time ago.
This will decide the Presidential election in 2020. The Democrats know what they want. The Republicans dont.
Hard times are coming.
Why they were allowed to amass a monopoly is another question for our AG.
The usual reason.
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