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Procedural History of UPMC – Highmark Litigation

Below is a summary of UPMC-Highmark dispute as of February 22, 2019. This information is limited to litigation proceedings with no discussion about prior contracts or negotiations.

 

  1. March 2011 – UPMC announces it will not renew UPMC-Highmark contract due to expire December 31, 2012.
  2. May 1, 2012 – Parties enter into mediated agreement which states that parties (UPMC and Highmark) will allow in-network access for all commercial, Medicare and Medicare Advantage members through December 31, 2014, and:
    • Parties would negotiate rates for access beginning in 2015 for Western Psych, oncology, UPMC Bedford and UPMC Northwest.
    • UPMC Children’s and Mercy agreements would remain in effect.
  3. April 23, 2013 – Pennsylvania Insurance Department approves Highmark – West Penn Allegheny Health System affiliation.
  4. June 12, 2013 – UPMC resolves to forego any extension of the existing commercial contracts, excluding Children’s, Mercy, Northwest and Western Psych as a result of the affiliation.
  5. June 27, 2014 – Pennsylvania Department of Health and Insurance intervene in the dispute and broker the Consent Decrees.  (Exhibit A)
  6. October 30, 2014 – Commonwealth Departments of Health and Insurance seeks to hold Highmark in contempt of Consent Decrees for marketing a Community Blue program that excluded UPMC participation.  Judge Pellegrini of Commonwealth Court denied the Commonwealth’s Petition.  (Exhibit B)
  7. November 30, 2015 – Pennsylvania Supreme Court rules that Highmark Medicare Advantage members should be treated by UPMC through June 30, 2019.  (Exhibit C)
  8. February 7, 2019 – Pennsylvania Attorney General Josh Shapiro petitions Commonwealth Court to modify the 2014 Consent Decree, alleging:  (Exhibit D)
    • The necessity to enforce compliance with charitable obligations
    • Violation of the Solicitation of Funds for Charitable Purposes Act
    • Breach of Fiduciary Duty
    • Violation of Uniform Trade Practices and Consumer Protection Law
  9. February 21, 2019 – UPMC files federal class action complaint in the United States District Court for the Middle District of Pennsylvania, alleging:  (Exhibit E)
    • Preemption by federal law
    • Violation of Accountable Care Act (ACA)
    • Violation of ERISA
    • Antitrust violation of the Sherman Act
    • Illegal takings in violation of the “Taking Clause of the Fifth Amendment” to the U.S. Constitution
    • Violation of federal Equal Protection
    • Violation of Due Process
  10. February 21, 2019 – UPMC also filed a Motion for a Preliminary Injunction in the U.S. District Court for the Middle District of Pennsylvania, in conjunction with the above Complaint, against the Attorney General.  (Exhibit F)
  11. February 21, 2019 – UPMC has also filed a Motion to Dismiss the Attorney General’s Petition to Modify the Consent Decree.  (Exhibit G)

For additional information contact Mike Cassidy or Mark Hamilton.

February 25, 2019

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