UPMC escalates legal fight with Highmark

UPMC MADE two legal maneuvers last week ratcheting up the stakes in its decadelong battle with Blue Cross and Blue Shield insurer Highmark Health.

The academic health system filed suit against Pennsylvania Attorney General Joshua Shapiro claiming he overstepped his authority when he sought to force the UPMC health system to accept Highmark members and any other outof-network patient in perpetuity. In a Feb. 7 petition to a state court, Shapiro claimed that UPMC was not meeting its charitable obligations as a tax-exempt organization. UPMC and Highmark are operating under a 2014 consent degree, slated to expire in June, that forced the two integrated delivery systems to maintain a business relationship.

UPMC, claiming that Shapiro’s action “fundamentally changes the law,” argues that the industry is based on competition between closed networks of providers and insurers.

In a related move, UPMC filed a petition to join a multistate suit against the Blue Cross and Blue Shield Association. That suit accuses dozens of Blues plans of illegally impeding competition by refusing to compete with one another. UPMC wants to contract with Blues plans other than Highmark once the consent degree expires, but their policies prevent it from doing so.

Plaintiffs already in the case include providers that accept Blues plans, said Joe Whatley, an attorney with Whatley Kallas who serves as co-lead counsel for the provider plaintiffs. Having UPMC file an injunction could help nudge the case to trial faster. Whatley said he has been trying to get the Blues to reach a settlement, but that hasn’t happened yet.

The Blue Cross and Blue Shield Association did not respond to a request seeking comment, and UPMC declined to comment beyond its court filings. ●