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UPMC Statement on Consent Decree

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Paul Wood
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4/27/2015

PITTSBURGH, April 27, 2015 – The Attorney General earlier today alleged that both UPMC and Highmark violated the Consent Decree.  While UPMC agrees with the allegation as to Highmark, a careful review clearly demonstrates there’s no substantive or legal basis for any of the Commonwealth’s misinformed claims against UPMC. 

Nor does requiring arbitration solve the issues that divide Highmark and UPMC.  As the Commonwealth has alleged, the Consent Decree required Highmark to arbitrate, on an expedited basis, its assertion that it can change the rates it is obligated to pay UPMC unilaterally.  Highmark then actively subverted and ultimately halted the mandated arbitration with litigation that the Commonwealth maintains “undermines” protections for seniors. 

UPMC filed formal complaints with the Commonwealth twice last fall stating Highmark’s unilateral violations of the current Medicare Advantage agreements, the 2012 Mediated Agreement and the 2014 Consent Decree would force UPMC to terminate the Medicare Advantage agreements with Highmark for 2016.  These warnings were ignored by the Commonwealth, and it missed the opportunity to enforce the arbitration clause and get this issue resolved by the Consent Decree’s December 31, 2014 deadline and the April 1, 2015 deadline for Medicare Advantage contracting renewals. 

The termination of UPMC Medicare Advantage agreements with Highmark will not harm seniors.  They can expect to enjoy the benefits of more choice and competition and, likely, lower insurance premiums if they choose to stay in a Medicare Advantage plan.  Seniors always have the option of opting out of Medicare Advantage and, instead, can enroll in “traditional” Medicare fee-for-service.