UnitedHealthcare v. Eiseman, Aplts. ( 2015 )

[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