By Jon Delano


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PITTSBUGH (KDKA) — Surrounded by local patients soon to be denied access to UPMC physicians and facilities, Attorney General Josh Shapiro filed a lawsuit against the health care giant.

“We have concluded that UPMC, one of the largest health care providers, health care insurers, and charitable institutions within our commonwealth, is not fulfilling its obligation as a public charity,” Shapiro said at a press conference in Pittsburgh Thursday afternoon.

Watch Shapiro’s full press conference —

 

In a 73-page complaint, the Attorney General asked that the consent decree between UPMC and Highmark that expires June 30 be modified and extended.

“The consent decree modifications would do three things: require UPMC and Highmark to work together, second, insure fairness for Pennsylvania taxpayers, and third protect access for all patients,” Shapiro said.

Without action, Highmark-insured consumers will soon lose lower priced in-network access to UPMC physicians and facilities.

“Having Highmark insurance through my husband’s work, I will no longer be able to see my UPMC oncologist who saved my life from a death sentence,” said Brittany Eckert of East Deer.

Eckert picked UPMC for its skilled doctors to treat a rare form of uterine cancer.

Now she feels abandoned.

“I didn’t choose to have cancer, but I did choose UPMC,” said Eckert, echoing a familiar advertising line and then adding, “UPMC won’t choose me. Instead they want to silence me.”

Shapiro says non-profits like UPMC that get public donations and are often untaxed owe a duty to Eckert and others who “pay to subsidize for the taxes UPMC doesn’t pay.”

“Then they pay through their employer for their Highmark health insurance. Then if they want to take their child to a doctor at a UPMC facility, they have to pay extra just to walk in the very hospital that their taxes helped build,” Shapiro said. “That’s outrageous, and that’s not fair. UPMC must behave in a manner consistent with its charitable mission in all facets of its operation.”

Shapiro asked both Highmark and UPMC to modify and extend a consent decree that expires June 30 so Highmark insureds can continue to use UPMC doctors and facilities.

“Highmark has agreed to those modifications. I’m also here today to announce that UPMC did not,” Shapiro said.

With that, Shapiro said filing a lawsuit against UPMC was his only recourse.

UPMC and its UPMC Health Plan insurance and Highmark and its Allegheny Health Network are now competing for both insurance customers and patients.

“They can basically put a wall up around their silo, shutting each other out, denying access to care, while driving up their own bottom line,” Shapiro said.

But if they do that, consumers lose, as one Highmark insured said about her UPMC cancer doctor.

“You should be able to go wherever and see whatever doctors you want to and be able to be treated no matter what insurance you have or what hospital it is,” Eckert said.

Watch Jon Delano’s report —

 

Shapiro credited UPMC for its charitable contributions, but added, “Still, the benefit of the bargain here for Pennsylvanians only exists if UPMC honors its public charity status not just some of the time in some of the cases but all of time as the law requires.”

UPMC says this is just an economic battle between two corporate giants, but Highmark CEO David Holmberg disagrees.

“These aren’t our companies. We didn’t put our equity in to build them. We’re stewards of the peoples’ money. These companies belong to the people of Pennsylvania,” Holmberg told KDKA money editor Jon Delano.

No one from UPMC would appear on camera to respond.

But in a written statement to KDKA, the non-profit insisted that consumers are benefitting from the competition, adding, “Nearly all businesses now offer alternative, affordable plans so their employees can choose insurance products that allow them full, unfettered in-network access to the UPMC hospitals and physicians they desire.”

Shapiro is asking the Commonwealth Court to act on his petition before June 30.

Highmark’s David Holmberg says Highmark is considering whether to file a friend of the court petition.

Obviously, the clock is ticking.