Healthcare giant UPMC's plans to terminate its Medicare Advantage contracts with insurer Highmark, which also owns a rival health system, has drawn threats of legal action from Pennsylvania state leaders.
"We have grown weary of the near-constant skirmishes between these parties, who both have been at fault at one time or another,” said Pennsylvania Attorney General Kathleen Kane in a statement. “The constant upheaval of services has created fear and confusion for consumers that we are in the process of trying to dispel.”
Kane said her office stands ready to pursue legal options to ensure patient access and affordability.
Pennsylvania Gov. Tom Wolf also weighed in, saying in a statement that his administration will “pursue all options to reverse this decision, including court action against UPMC if that is what is required,” according to the Pittsburgh Tribune-Review.
Wolf accused UPMC of violating a consent decree reached between Highmark and UPMC last summer.
“It is a clear violation of UPMC's commitment to protect senior citizens and vulnerable populations as enshrined in the consent decree,” Wolf said. “I intend to fight this action and stand firmly with our senior citizens.”
UPMC announced Wednesday that it would end its Advantage contracts with Highmark at the end of the year, saying that nearly a year ago Highmark stopped paying UPMC contracted rates for cancer care. UPMC said in a statement on its website that the consent decree allows UPMC to end the contracts under such circumstances.
UPMC spokesman Paul Wood said Highmark reduced its payments to UPMC for oncology services by 80% and owes the system $143 million.
“This is not a negotiating ploy or tactic, and it's not about asking for more money,” Wood said. “This is about honoring the terms of an existing contract, and it would just be farcical and ridiculous to enter into a contract with an organization that reserves the right to change terms whenever they want.”
Highmark, however, disputes that.
“It's sad but true that when you get past all the misrepresentations and accusations, that UPMC's action is all about money,” Highmark said in a statement. “Because of Highmark's leadership in keeping cancer care affordable—and saving area employers and self-insured individuals from paying grossly inflated prices for cancer drugs—UPMC is holding 180,000 seniors hostage."
Some have suggested UPMC's announcement might be retribution for a lawsuit Highmark filed against UPMC in September over prices the system charged to administer cancer drugs and services. Wood, however, said the decision to end the contracts with Highmark has nothing to do with that lawsuit.
UPMC and Highmark have been fighting over a number of issues for years, and a contract between the two expired at the end of last year. A transition plan approved by the Pennsylvania Insurance Department outlined which UPMC facilities and services would be in-network and out-of-network after the contract's expiration. That followed a consent decree signed in June outlining similar measures.
