UPMC-Highmark cancer care dispute lands in court

A dispute between Pittsburgh-based UPMC and health insurer Highmark over how much UPMC should be paid for cancer care has made its way to the Allegheny County Common Pleas Court where arguments will be heard March 2, according to a Pittsburgh Business Times report.

Medicare regulations allow health systems to bill insurers hospital outpatient centers' rates for the same care provided in system-owned physicians' offices, a practice that sometimes leads to reimbursement being tripled.

However, Highmark stopped paying UPMC the higher rates in April 2014. UPMC called Highmark's refusal to pay the higher markup an "egregious contract violation," according to the report.

UPMC is attempting to enforce the terms of its contract with the health insurer, which, according to Highmark, would increase reimbursement to UPMC by $200 million annually.

The hearing March 2 will focus on the procedure for resolving the dispute, since UPMC and Highmark cannot agree on the procedure that was provided in the consent decree they signed in July 2014, according to the report.

More articles on healthcare industry lawsuits:

Supreme Court case could generate tidal wave of healthcare fraud cases
Cleveland Clinic accused of Medicare fraud in False Claims Act lawsuit
South Shore Physician Hospital Organization settles kickback lawsuit for $1.8M

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