State court says feds govern Medicare Advantage marketing


The battle between Highmark and the University of Pittsburgh Medical Center (UPMC) has led to a more wide-reaching issue--whether state or federal officials have authority over Medicare Advantage plans. But a new state court ruling found that it's the feds who regulate Medicare Advantage marketing and advertising practices, not states, reports the Pittsburgh Business Times. 

The Pennsylvania Attorney General and the departments of health and insurance alleged in a request for an injunction that Highmark must expand its Medicare Advantage plans to include UPMC within its network. The officials claimed that by excluding UPMC from its network, the new plans violate a consent agreement that Highmark made with UPMC when the companies decided to stop working together, FierceHealthPayer previously reported.

But Commonwealth Court President Judge Dan Pellegrini found that Highmark didn't go against the consent decree and wasn't misleading in its advertisements for the Medicare Advantage plan, according to a Highmark announcement

"Finally, we find nothing unclear or misleading about Highmark's verbal statements that all Medicare-eligible seniors will have access to in-network UPMC services," Pellegrini stated, according to the Pittsburgh Business Times. "Indeed, all such seniors have the option in enrolling in several Medicare Advantage plans and only one excludes in-network UPMC services."

UPMC was disappointed over the ruling. "Now, there's more uncertainty than ever about the consent decree's protections and the in-network access to UPMC that Highmark subscribers will have when the existing contracts expire in two months," UPMC spokesman Paul Wood said in a statement acquired by the Pittsburgh Business Times

Before state regulators filed their complaint in court, UPMC threatened legal action over Highmark's plans, but Wood wouldn't comment about the health system's next steps, reported the Pittsburgh Tribune-Review.

To learn more:
- here's the Highmark announcement 
- read the Pittsburgh Business Times article
- see the Pittsburgh Tribune-Review article

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Do state officials have authority over Medicare Advantage insurers?
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