Court says UPMC must keep cheaper rates in Medicare plans

HARRISBURG, Pa. (AP) — Pennsylvania seniors and others enrolled in an insurer's Medicare Advantage plans won't have to pay comparatively higher rates in the coming years for services through the University of Pittsburgh Medical Center, the state Supreme Court ruled Monday.

The court ruled 3-2 that about 180,000 people in Highmark's Medicare Advantage plans will continue to pay UPMC's "in-network" fees at least until June 2019, when a consent decree involving the two health providers is set to expire.

Justice Debra Todd, writing for the majority, upheld a lower court ruling that the consent decree requires UPMC to treat its doctors, hospitals and other services as in-network for Highmark Medicare Advantage patients.

In a dissent, Justice Max Baer said that contradicted language in the consent decree.

"It is not within this court's authority to reinsert the protection for Medicare Advantage into the vulnerable population provision when it was specifically removed by the parties," Baer wrote. "We also cannot read an otherwise clear sentence addressing a separate concept as ambiguous."

The case is part of a bitter dispute that dates back to several years to when Highmark began to acquire what's now the seven-hospital Allegheny Health Network, and UPMC began to see the insurer as a competitive rival.

UPMC told Highmark and the state Insurance Department in March that it would end its Medicare Advantage contracts with Highmark at the end of the year. That prompted the attorney general's office to go to court in an effort to enforce the consent decree — technically two nearly identical decrees because, as Todd wrote, the two sides would not sign the same document.

"We're very pleased with the court's decision," said Chuck Ardo, spokesman for the attorney general's office, which negotiated the agreement. "We are currently reviewing it but believe strongly that it is in the best interests of the people of western Pennsylvania."

Highmark called the ruling a win for western Pennsylvania residents, particularly seniors.

UPMC said it would comply with the decision but was disappointed.

"It's not ... what we think was clear from the plain language of the consent decree," said UPMC lawyer Stephen Cozen.

The decision applies to Highmark's Security Blue HMO and Freedom Blue PPO plans.