Pittsburgh-based UPMC is accusing Pittsburgh-based Gateway Health Plan of cutting payments for care provided at UPMC hospitals, according to Trib Live.
The accusation against Gateway, which is co-owned by Pittsburgh-based Highmark with Conshohocken, Pa.-based Mercy Health System, comes via a civil lawsuit filed Monday. UPMC claims Gateway underpaid the system's hospitals by 2 percent for Medicare Advantage beneficiaries in 2013 after CMS reduced payments to Gateway by the same amount, according to the report. Gateway, the lawsuit claims, has said the payment cuts were supposed to be passed along to hospitals and physicians, according to the report. However, by cutting the payments, UPMC claims Gateway did not honor its end of Medicare Advantage contracts.
The lawsuit also claims Gateway owes UPMC money for emergency department services from July 2015 to August 2016, reports Trib Live. In the lawsuit, UPMC claims Gateway violated a contract with the hospital system when it paid UPMC the "lowest rate for any non-emergent services provided in EDs" rather than "based on the standard practice of paying more for more complex services," according to the report. The lawsuit notes Gateway recommenced contracted payment in August 2016, according to the report.
A Gateway spokeswoman told Trib Live the company's attorneys are reviewing the lawsuit, but declined to discuss it further.
More articles on legal and regulatory issues:
Shuttered NC hospital's settlement over improper layoff notifications receives preliminary approval
How technology can help hospitals base malpractice reserves on more than a gut feeling
Michigan hospital pays $791k to resolve false billing allegations