Post by Carpenter, McCadden & Lane, LLP

The Supreme Court of Pennsylvania has dealt a severe blow to employers and their insurers in its reversal of the Commonwealth Court’s decision in 700 Pharmacy v. Bureau of Workers’ Compensation Fee Review Hearing Office (SWIF). The Commonwealth Court had determined that pharmacies provide “goods and services” and were therefore included in the prohibited self-referral language of Section 306(f.1)(3)(iii) of the Act. In this case, Dr. Miteswar Purewal and/or Dr. Shailen Jalali were Claimant’s treating physicians. They also held ownership interests in 700 Pharmacy where Claimant’s prescriptions were being filled. The Commonwealth Court held this was a prohibited self- referral. The Supreme Court said it was not a prohibited self-referral, because it was not one of the enumerated entities in Section 306(f.1)(3)(iii) [laboratory, physical therapy, rehabilitation, chiropractic, radiation oncology, psychometric, home infusion therapy or diagnostic imaging, goods or services]. According to the Court, if the legislature had intended to include pharmacies, they would have said so, or they would have placed an “or” between “diagnostic imaging” and “goods and services.” I am not sure that we can take solace in the fact that the Court does not believe that its holding will “embolden medical providers to prescribe unnecessary or harmful medication for pecuniary gain or to commit any other nefarious actions.” #PAWorkersComp #WorkersCompensation #RiskManagement