UPMC-Highmark Agreement Can't Be Extended: Judge

PITTSBURGH, PA - A Pennsylvania Commonwealth Court judge has ruled that the UPMC-Highmark consent decree will end June 30. That increases the chances that most Highmark-insured patients will become out-of-network at UPMC medical facilities effective July 1.

The ruling is a setback for Pennsylvania Attorney General Josh Shapiro, who filed a lawsuit against in February seeking to extend the agreement that has given Highmark members in-network access to UPMC physicians and hospitals. Shapiro’s office plans to appeal the decision to the state Supreme Court.

Judge Robert Simpson did not dismiss Shapiro’s lawsuit, but noted in a 45-page opinion that the Supreme Court already has ruled that the consent decree’s expiration date cannot be modified or extended indefinitely.

Commonwealth Court, Simpson wrote, “lacks the power or authority to modify the termination date of the consent decree without the consent of (UPMC and Highmark), even if it were in the public interest to do so.”

Simpson said that Shapiro does have the right to seek to alter the agreement for the public good. The judge also denied or deferred several other objections raised by UPMC.

Simpson did not rule on Shapiro’s claims of unfair trade practices or that UPMC is not abiding by its charitable obligations to the state.

When Shapiro filed the lawsuit, he said his goal was "to restore fairness to the healthcare system in western Pennsylvania and promote the public interest by ensuring patient access to affordable care and facilities which they have funded through their tax dollars.”