Pennsylvania attorney general takes legal action against UPMC over patient access

The Pennsylvania Attorney General's office filed a petition against UPMC, arguing the Pittsburgh-based health system is not in compliance with the state's Public Charity law, according to the Pittsburgh Post-Gazette.

Five things to know:

1. The petition seeks to modify a consent decree between UPMC and Pittsburgh-based Highmark that is set to expire June 30. Starting July 1, roughly 175,000 Highmark Medicare Advantage plan members will lose in-network access to 11 UPMC hospitals and most UPMC physicians.

2. At a press conference Feb. 7, Pennsylvania Attorney General Josh Shapiro said he requested "common sense" changes to the consent decree, which Highmark accepted. However, UPMC refused to make the changes.

3. Mr. Shapiro claims UPMC has violated state law by restricting access to its network of hospitals and physicians. He said a legal review by his office revealed UPMC violated its charitable obligations by not negotiating with self-insured employers and denying access to certain patients who are covered by a competing health plan, according to the Pittsburgh Business Times.

"We have concluded that UPMC is not fulfilling its obligation as a public charity," Mr. Shapiro said at the news conference, according to the Pittsburgh Business Times. "I can't sit by and see seniors and children and workers suffer because of corporate greed. UPMC is simply taking more than its fair share."

4. At the press conference, Mr. Shapiro said modifications must be made to the consent decree "to keep UPMC from inflicting harm on the public," according to the Pittsburgh Post-Gazette. His petition is seeking changes that require UPMC to accept binding arbitration if an impasse is reached in contract negotiations with an insurer. The modified consent decree would protect patients from "excessive and unreasonable billing practices."

5. In a statement to the Pittsburgh Business Times, UPMC said businesses and patients have had plenty of time to prepare for its split with Highmark since the organizations entered into the consent decree five years ago.

"During that period, the region's insurance marketplace transformed from one of the nation's most highly concentrated and least competitive to one of the most competitive and pro-consumer markets in the nation with some of the lowest cost health plans available anywhere," the statement read.

Access the full Pittsburgh Post-Gazette article here.

Access the full Pittsburgh Business Times article here.

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