UPMC has filed an amended complaint in U.S. District Court accusing insurer Highmark Inc. and the West Penn Allegheny Health System of conspiring against UPMC and its health plan.
The complaint alleges that Highmark operates as a monopoly that unilaterally controls health insurance premiums in the region while also dictating reimbursement rates it pays to hospitals.
Specifically, the complaint charges that Highmark "hatched and executed a plan to destroy UPMC as a negotiating entity, starve UPMC Health Plan of the revenues necessary to emerge as a significant insurance competitor, and stifle competition from other insurers."
It further accuses West Penn Allegheny of deliberately maintaining excess capacity to give Highmark leverage over other providers, such as UPMC, that seek higher reimbursement rates. In return for this consideration, the complaint says, Highmark continues to financially prop up the financially-ailing West Penn Allegheny system.
Highmark spokesman Aaron Billger said late Thursday that Highmark had just received the lawsuit and its attorneys were reviewing it, adding that, "Highmark's core focus remains centered on preserving access to affordable, high-quality health care choices for the entire community."
UPMC, though, accuses Highmark of deliberately keeping reimbursement rates low to prevent UPMC from making UPMC Health Plan a viable competitor in the insurance market.
The complaint further alleges that since Highmark's recently announced affiliation with Jefferson Regional Health System in Jefferson Hills, Highmark has steered patients away from UPMC facilities to Jefferson, and had more complex cases at Jefferson referred to West Penn Allegheny facilities.businessnews - health
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