UnitedHealthcare v. Eiseman, Aplts.

• Court: Supreme Court of Pennsylvania
• Decided: October 27, 2015
• Docket: 47 EAP 2014
• Status: Published

Opinion

[J-28A-2015, J-28B-2015 and J-28C-2015] [MO: Saylor, C.J.] IN THE SUPREME COURT OF PENNSYLVANIA EASTERN DISTRICT

COMMONWEALTH OF PENNSYLVANIA, : No. 45 EAP 2014 DEPARTMENT OF PUBLIC WELFARE, : : Appeal from the Order of the Appellee : Commonwealth Court entered on : 02/19/2014 at No. 1935 CD 2012 affirming : in part and reversing in part the v. : determination entered on 09/17/2012 of the : Office of Open Records at No. : AP2011-1098. JAMES EISEMAN, JR. AND THE PUBLIC : INTEREST LAW CENTER OF : ARGUED: May 5, 2015 PHILADELPHIA, : : Appellants :

AETNA BETTER HEALTH, INC., HEALTH : No. 46 EAP 2014 PARTNERS OF PHILADELPHIA, INC., : AND KEYSTONE MERCY HEALTH : Appeal from the Order of the PLAN, : Commonwealth Court entered 02/19/2014 : at No. 1949 CD 2012 affirming in part and Appellees : reversing in part the determination entered : on 09/17/2012 of the Office of Open : Records at No. AP2011-1098. v. : : ARGUED: May 5, 2015 : JAMES EISEMAN, JR., AND THE PUBLIC : INTEREST LAW CENTER OF : PHILADELPHIA, : : Appellants :

UNITEDHEALTHCARE OF : No. 47 EAP 2014 PENNSYLVANIA, INC. D/B/A : UNITEDHEALTHCARE COMMUNITY : Appeal from the Order of the PLAN AND HEALTHAMERICA : Commonwealth Court entered 02/19/2014 PENNSYLVANIA INC. D/B/A : at No. 1950 CD 2012 affirming in part and COVENTRYCARES, : reversing in part the determination entered : on 09/17/2012 of the Office of Open Appellees : Records at No. AP2011-1098. : : ARGUED: May 5, 2015 v. : : : JAMES EISEMAN, JR. AND THE PUBLIC : INTEREST LAW CENTER OF : PHILADELPHIA, : : Appellants :

DISSENTING OPINION

MR. JUSTICE EAKIN DECIDED: October 27, 2015 I agree with the Commonwealth Court’s majority that documents containing MCO

Rates are not “financial records” within § 102 of the RTKL, 65 P.S. § 67.102. See Dep’t

of Public Welfare v. Eiseman, 85 A.3d 1117, 1127 (Pa. Cmwlth. 2014) (en banc)

(“Because MCO Rates are not disbursed ‘by an agency,’ [the] OOR erred in concluding

MCO Rates are ‘financial records.’”). MCO Rates are rates set by a private company,

not an agency. The private company disburses the funds — the agency does not.

While the entire scheme of payment immediately suggests bureaucratic confusion and

obfuscation, the plain language of the RTKL does not cover this situation — perhaps it

should, but as it currently exists, in my judgment it does not.

I would remand the matter to the OOR to decide, in the first instance, whether the

MCO Rates are exempt from disclosure under § 708(b)(11). Contra id. (“Because we

conclude the MCO Rates are not ‘financial records,’ we next consider the RTKL

exceptions that OOR did not fully analyze based on its adherence to Lukes[ v. Dep’t of

Public Welfare, 976 A.2d 609 (Pa. Cmwlth. 2009)]. Typically, we would remand to [the]

OOR to serve as fact-finder.”). Thus, I respectfully dissent.

[J-28A-2015, J-28B-2015 and J-28C-2015] [MO: Saylor, C.J.] - 2