Highmark, Pennsylvania's largest health insurer, filed a lawsuit last week against hospital and provider network UPMC alleging it has violated federal false advertising laws in its "Keep Your Doctor" advertising campaign.
The lawsuit is the latest salvo in the months-long, ongoing public battle between Western Pennsylvania's largest insurer and UPMC, the largest healthcare operator in the region with 19 hospitals.
"The misinformation campaign is designed to panic employers and healthcare consumers into thinking that they have to sever all ties with Highmark immediately because the Highmark/UPMC relationship will be totally and permanently severed as of June 30, 2012," according to the complaint filed by Highmark in United Sates District Court.
Further, Highmark contends the campaign that has run in print, on radio, via direct communications and on its companion website, keepyourdoc.com, is in direct retaliation for Highmark's proposed takeover of UPMC competitor West Penn Allegheny Health System.
"UPMC and Highmark (or their predecessors) have continued to do business together for decades, even as UPMC acquired more and more of the hospitals serving Western Pennsylvania, and even after UPMC decided to become a direct competitor of Highmark by offering its own healthcare insurance plans, in the late 1990s," the lawsuit states. "Now, however, UPMC seeks to punish Highmark for having the temerity to help preserve West Penn (which employs more than 13,000 people) as an alternative healthcare provider to UPMC to allow Western Pennsylvania consumers a choice of providers as well as access to additional providers."
UPMC spokesman Paul Wood, called the lawsuit "meritless" in an email response and stated that the lawsuit "drives home the point that its current contracts with UPMC will expire on June 30, 2012, and that there will not be a new contract."
Highmark contends the current UPMC campaign falsely portrays the relationship between the two as ending permanently in 2012 once the contract runs out, and with it Highmark members' access to UPMC doctors and facilities, when, in fact, a "run out" period would preserve access for another year.
The purpose, Highmark contends is to get its members to jump ship immediately to either UPMC's own health plan or to other national insurers Aetna, CIGNA, HealthAmerica or United Healthcare, all plans that UPMC has contracted with since the beginning of the year.
But UPMC disagrees with Highmark's interpretation of the current contract regarding the run-out period and will present their interpretation in defense of the lawsuit. Meanwhile, UPMC officials say the best course of action for the two companies would be to sit down to negotiate how to run-down the relationship in the coming month.
"We do regret…Highmark's unwillingness to accept our repeated invitations to discuss how to best unwind our relationship in a manner that minimizes disruption and concern," said Wood. "Perhaps this lawsuit will bring them to that table."
The invitation to a negotiated end to the relationship is not one Highmark relishes. Despite negotiations for a new contract breaking down in spring, when it became apparent Highmark would be looking to resuscitate ailing West Penn Allegheny, Highmark has left the door open for continuing talks.
It seems apparent, however, UPMC is moving on, as evidenced by the new contracts it signed with health plans that have been bit players in the market.
"There will not be a renewal of the contract," Wood stated. "They are going to become a direct competitor. If UPMC was in their network, Highmark would use our good name to market to employers that through UPMC they are going to get some of the best doctors in the entire world and one of the best systems in the country. But West Penn Allegheny runs at 60 percent capacity and there is no way they will continue to operate that way. There is no way we are going to allow our good name be used to raise dollars for Highmark and have them steer their members to a competing health system."