[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] IN THE SUPREME COURT OF PENNSYLVANIA MIDDLE DISTRICT
TODD, C.J., DONOHUE, DOUGHERTY, WECHT, MUNDY, BROBSON, McCAFFERY, JJ.
700 PHARMACY, : No. 97 MAP 2024 : Appellant : Appeal from the Order of the : Commonwealth Court at No. 560 CD : 2020 dated May 16, 2024 Affirming v. : the Decision of the Bureau of : Workers' Compensation at No. DSP- : 2809684-1 dated May 20, 2020. BUREAU OF WORKERS' : COMPENSATION FEE REVIEW HEARING : ARGUED: November 19, 2025 OFFICE (STATE WORKERS' INSURANCE : FUND), : : Appellee :
700 PHARMACY, : No. 98 MAP 2024 : Appellant : Appeal from the Order of the : Commonwealth Court at No. 561 CD : 2020 dated May 16, 2024 Affirming v. : the Decision of the Bureau of : Workers' Compensation at No. DSP- : 3130152-3 dated May 20, 2020. BUREAU OF WORKERS' : COMPENSATION FEE REVIEW HEARING : ARGUED: November 19, 2025 OFFICE (STATE WORKERS' INSURANCE : FUND), : : Appellee :
700 PHARMACY, : No. 99 MAP 2024 : Appellant : Appeal from the Order of the : Commonwealth Court at No. 562 CD : 2020 dated May 16, 2024 Affirming v. : the Decision of the Bureau of : Workers' Compensation at No. DSP- : 2917433-2 dated May 20, 2020. : BUREAU OF WORKERS' : ARGUED: November 19, 2025 COMPENSATION FEE REVIEW HEARING : OFFICE (STATE WORKERS' INSURANCE : FUND), : : Appellee
700 PHARMACY, : No. 100 MAP 2024 : Appellant : Appeal from the Order of the : Commonwealth Court at No. 563 CD : 2020 dated May 16, 2024 Affirming v. : the Order of the Bureau of Workers' : Compensation at No. DSP-942461-8 : dated May 20, 2020. BUREAU OF WORKERS' : COMPENSATION FEE REVIEW HEARING : ARGUED: November 19, 2025 OFFICE (STATE WORKERS' INSURANCE : FUND), : : Appellee :
700 PHARMACY, : No. 101 MAP 2024 : Appellant : Appeal from the Order of the : Commonwealth Court at No. 564 CD : 2020 dated May 16, 2024 Affirming v. : the Order of the Bureau of Workers' : Compensation at No. DSP-3242427- : 2 dated May 20, 2020. BUREAU OF WORKERS' : COMPENSATION FEE REVIEW HEARING : ARGUED: November 19, 2025 OFFICE (STATE WORKERS' INSURANCE : FUND), : : Appellee :
OPINION
JUSTICE MUNDY DECIDED: June 16, 2026
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 2 In 1993, the General Assembly enacted Act 44 amending the Workers’
Compensation Act (the “WCA” or the “Act”). 1 Included in those amendments was Section
306(f.1)(3)(iii), see 77 P.S. § 531(3)(iii), commonly referred to as the Anti-Referral
Provision. That provision states, in pertinent part, that:
Notwithstanding any other provision of law, it is unlawful for a provider to refer a person for laboratory, physical therapy, rehabilitation, chiropractic, radiation oncology, psychometric, home infusion therapy or diagnostic imaging, goods or services pursuant to this section if the provider has a financial interest with the person or in the entity that receives the referral. 77 P.S. § 531(3)(iii).
In these consolidated appeals we must determine whether the Anti-Referral
Provision’s prohibition on self-referrals is limited to the eight enumerated categories of
services or whether the phrase “goods or services” acts as a catchall category bringing
unenumerated types of services, including prescription drugs and professional
pharmaceutical services, within the provision’s purview. After careful consideration, we
determine the plain language of the statute evidences that the ban on self-referrals is
limited to the enumerated list. We therefore reverse the holding of the Commonwealth
Court.
The pertinent facts in each of the consolidated cases are identical. Drs. Miteswar
Purewal and/or Shailen Jalali were the treating physicians for several patients who had
sustained injuries arising during the course of the patients’ respective employment. As a
result of their work-related injuries, the patients were receiving workers’ compensation
benefits pursuant to the WCA and were considered claimants under the Act. As part of
the claimants’ treatment plans, Drs. Purewal and/or Jalali wrote prescriptions for various
medications, which were filled by 700 Pharmacy (the “Pharmacy”). The State Workers’
Insurance Fund (the “Insurer”), the insurance carrier for the claimants’ respective
1 Act of June 2, 1915, P.L. 736, No. 338 (as amended, 77 P.S. §§ 1-1041.4; 2501-2625).
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 3 employers, however, refused to pay for the claimants’ prescriptions. As a result of the
Insurer’s refusal, the Pharmacy filed Fee Review Applications in the Bureau of Workers’
Compensation (the “Bureau”) Medical Fee Review Office. In response to the Pharmacy’s
petitions, the Insurer asserted it was not required to pay for the prescriptions pursuant to
the Anti-Referral Provision because the prescriptions were the result of unlawful self-
referrals. The matters were thus scheduled for hearings before a hearing officer from the
Medical Fee Review Hearing Office.
Before the hearing officer, Drs. Purewal and Jalali stipulated that they had a
financial interest in the Pharmacy. Despite that stipulation, the Pharmacy contended that
the treatments in question did not have their genesis in prohibited self-referrals because
the Anti-Referral Provision does not include a bar on self-referrals for prescription drugs
and pharmaceutical services. The hearing officer rejected this argument, instead finding
that while the Anti-Referral Provision does not specifically identify prescription drugs,
prescriptions for medications are plainly captured within the statute’s inclusion of “goods
or services.” According to the hearing officer, in light of the WCA’s “foundational liability
principle” that employers are required to provide payment for claimants’ reasonable
surgical and medical supplies, including, inter alia, “medicines and supplies, as and when
needed,” Hearing Officer Decision, Conclusions of Law, ¶ 4 (quoting 77 P.S. § 531(1)(i)) 2,
it would be “unsatisfactory to believe that medications are not included in the phrase [ ]
‘goods or services.’” Id.
2 The hearing officer issued five separate opinions, one for each individual claimant. The findings of fact and conclusions of law in each opinion are identical, save for details related to each claimants’ respective treatment that are not relevant to our analysis. For ease of discussion, we will cite only to the opinion in the matter pertaining to Aleathia Johnson, MF-573565, et. al. All cited findings of fact and conclusions of law, however, are equally applicable to the cases pertaining to all five claimants.
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 4 The hearing officer further relied on our statement in Eighty-Four Mining Co. v.
Three Rivers Rehabilitation, 721 A.2d 1061 (Pa. 1998), that the purpose of the Anti-
Referral Provision was to “contain costs by preventing physicians from acting in their own
self-interest.” Id. (quoting Eighty-Four Mining, 721 A.2d at 1067). To that end, the hearing
officer concluded that the Department of Labor & Industry (the “Department”), through its
regulations, “made clear that the legislature, with Act 44, was intending for [the Anti-
Referral Provision] to put into practice the federal Stark [a]mendments[3], which prohibited
self-referrals under the Medicare program.” Id. In support of this conclusion, the hearing
officer cited the Department’s Medical Cost Containment regulations, which state, inter
alia, “[r]eferrals permitted under all present and future Safe Harbor regulations
promulgated under [the Medicare Act] …, and all present and future exceptions to the
Stark amendments to the Medicare Act …, and all present and future regulations
promulgated thereunder are not prohibited referrals involving financial interest ….” Id.
(quoting 34 Pa. Code § 127.301(c)). Importantly, the hearing officer observed that the
Stark amendments explicitly include “outpatient prescription drugs” among the
designated health services (“DHS”) for which physicians are prohibited from making self-
referrals. Id. On the other hand, prescription drugs are not included in any of the Stark
amendment’s safe harbor regulations exempting certain self-referrals from that
prohibition. Id.
Based on the foregoing, the hearing officer found the at-issue treatments had “their
genesis in [ ] prohibited self-referral[s]” and, thus, denied the Pharmacy’s fee review
3 The Stark amendments is a reference to Section 1877 of the federal Social Security Act,
42 U.S.C. § 1395nn, which bans self-referrals for designated health services (“DHS”) under the Medicare program. Outpatient prescription drugs are included in the definition of DHS. 42 U.S.C. § 1395nn(h)(6). The statute also includes exceptions to the general ban on self-referrals, but outpatient prescription services are not included in any of those exceptions. See id. at 1395nn(b).
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 5 applications. Id. The Pharmacy petitioned the Commonwealth Court for review of the
hearing officer’s decision. 4 Before the Commonwealth Court, the Pharmacy again argued
that the Anti-Referral Provision’s bar on self-referrals applied only to the categories of
services specifically enumerated in the statute, and that since prescription drugs and
professional pharmaceutical services are not among those enumerated categories, they
are not encompassed within the Anti-Referral Provision’s ambit. The court rejected the
Pharmacy’s argument and affirmed the hearing officer’s determination. 5
The court first addressed 6 the Pharmacy’s argument that the Anti-Referral
Provision does not encompass prescription drugs and professional pharmaceutical
services and that the phrase “goods or services” must be construed in light of the
4 While the hearing officer denied the Pharmacy’s fee review applications, he did determine that the Pharmacy was a healthcare provider with standing to initiate a Fee Review Application pursuant to Section 109, 77 P.S. § 29, and Section 306(f.1)(5), 77 § 531(5), of the WCA. Hearing Officer Decision, Conclusions of Law, ¶ 3. The Insurer petitioned the Commonwealth Court for review of this determination. The court affirmed the hearing officer’s determination and the Insurer failed to petition this Court for allowance of appeal of that holding. As such, we will not discuss that issue further. 5 Similar to the hearing officer, the Commonwealth Court issued five separate opinions in
these matters, one for each individual claimant. The court issued a published opinion in 700 Pharmacy v. Bureau of Workers’ Compensation Fee Review Hearing Office, 315 A.3d 914 (Pa. Cmwlth. 2024), and then four unpublished memorandum opinions, affirming the hearing officer’s determination on the basis of its analysis in 700 Pharmacy. For ease of reference, all citations are to 700 Pharmacy, but the court’s analysis is applicable to all five cases. 6 The court began its analysis by recognizing the issue before it was one of statutory
interpretation. Accordingly, the panel observed that the ultimate goal of statutory interpretation is to ascertain the intent of the General Assembly and that the words of a statute “where clear and free from all ambiguity … are presumed to be the best indication of legislative intent.” 700 Pharmacy, 315 A.3d at 924 (quoting Hannaberry HVAC v. Workers’ Comp. Appeal Bd. (Snyder, Jr.), 834 A.2d 524, 531 (Pa. 2003)). Only when the statute is ambiguous, the court maintained, may it consider administrative interpretations. Id. (citing 1 Pa.C.S. § 1921(c)). The court continued that a statute is ambiguous when it is subject to at least two reasonable interpretations. Id. (internal citation omitted).
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 6 preceding more specific terms pursuant to Section 1903(b) of the Statutory Construction
Act 7, 1 Pa.C.S. § 1903(b). 8 According to the court, it previously explained that Section
1903(b) was a codification of the ejusdem generis canon of construction, which provides
that “where general words follow the enumeration of particular classes of persons or
things, the general words will be construed as applicable only to persons or things of the
same general nature or class as those enumerated.” 700 Pharmacy, 315 A.3d at 924
(quoting S.A. by H.O. v. Pittsburgh Pub. Sch. Dist., 160 A.3d 940, 946 (Pa. Cmwlth.
2017)). The panel continued that typically the ejusdem generis canon involves a
“catchall” phrase following or preceding a specific enumeration such as “including but not
limited to” or “any other.” Id. (internal citations omitted).
The court acknowledged that the Anti-Referral Provision does not include any such
paradigmatic catchall phrase but nevertheless concluded that the lack of such language
did not preclude it from reading “goods or services” as a catchall category. Id. While
recognizing the case was not dispositive, the court noted that in Bennett v. Jeld Wen, Inc.
(Workers’ Comp. Appeal Bd.), 306 A.3d 949 (Pa. Cmwlth. 2023), it “read the [phrase]
‘goods or services’ quite naturally as serving as a catchall term to include other types of
goods or services not specifically enumerated” in the Anti-Referral Provision and the
language could be read as “it is unlawful for a provider to refer a person for … goods or
services.” Id. (quoting Bennett, 306 A.3d at 959) (ellipsis in original and emphasis
removed). Accordingly, the court read the phrase “goods or services” to “suggest the
General Assembly did not intend to restrict the [A]nti-[R]eferral [P]rovision’s sweep only
to the specific items enumerated but left a broader category open.” Id. Observing that
7 1 Pa.C.S. §§ 1901–1991.
8 “General words shall be construed to take their meanings and be restricted by preceding
particular words.” 1 Pa.C.S. § 1903(b).
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 7 the Act does not define “goods,” the court, relying on the dictionary definition, defined the
term as “things that are produced for sale … merchandise, wares … economic assets
which have tangible, physical form (contrasted with services).” Id. (ellipses in original and
internal citation omitted). Employing this definition, the court agreed with the Insurer that
prescription drugs qualify as “goods” under the Anti-Referral Provision. Moreover,
applying the ejusdem generis canon, the court found that “the enumerated items are wide-
ranging topics across medical disciplines” which “are all medical in nature, and drugs and
pharmaceutical services fall within the ‘same general nature or class as those
enumerated.’” Id. (quoting S.A., 160 A.2d at 946). As such, the court concluded that
prescription drugs and professional pharmaceutical services fall comfortably within the
Anti-Referral Provision’s “goods or services” catchall.
Having concluded the plain text of the Anti-Referral Provision covers prescription
drugs and professional pharmaceutical services, the court found the hearing officer
properly denied and dismissed the Pharmacy’s fee applications because they originated
from prohibited self-referrals.
The Pharmacy filed five separate petitions for allowance of appeal raising an
identical issue, which this Court granted:
Section 306(f.1)(3)(iii) of the Workers’ Compensation Act makes it “unlawful for a provider to refer a person for laboratory, physical therapy, rehabilitation, chiropractic, radiation oncology, psychometric, home infusion therapy or diagnostic imaging, goods or services pursuant to this section if the provider has a financial interest with the person or in the entity that receives the referral.” Because this provision neither includes nor refers to “prescription drugs” or “professional pharmaceutical services,” is a pharmacy entitled to payment for prescription drugs and pharmaceutical services provided to a [c]laimant whose physician has a financial interest in the pharmacy? 700 Pharmacy v. Bureau of Workers’ Comp. Fee Review Hrg. Office, 330 A.3d 1244 (per
curiam). This issue presents the Court with a question of statutory interpretation, which
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 8 is a question of law. As such, our standard of review is de novo and our scope of review
is plenary. Schmidt v. Schmidt, Kirifides and Rassia, PC (Workers’ Comp. Appeal Bd.),
333 A.3d 310, 318 (Pa. 2025)).
With respect to questions of statutory interpretation, we are guided by the Statutory
Construction Act, which provides that the object of all statutory interpretation “is to
ascertain and effectuate the intention of the General Assembly.” 1 Pa.C.S. § 1921(a).
The act further directs that “[w]hen the words of a statute are clear and free from all
ambiguity, the letter of it is not to be disregarded under the pretext of pursuing its spirit.”
Id. at § 1921(b); see also Miller v. Cnty. Of Centre, 143 A.3d 917, 922 (Pa. 2016) (“A
statute’s plain language generally provides the best indication of legislative intent.”
(internal citation omitted)). As such, it is only when a statute is ambiguous that we may
attempt to ascertain the General Assembly’s intent by taking into account considerations
outside the statutory text, such as the object to be attained by the statute, the
consequences of a particular interpretation, and administrative interpretations of the
statute. 1 Pa.C.S. § 1921(c)(4), (6), and (8).
A statute is ambiguous when it is subject to two or more reasonable interpretations.
City of Phila. v. City of Phila. Tax Review Bd. ex rel. Keystone Health Plan East, Inc., 132
A.3d 946, 952 (Pa. 2015). However, courts “must not overlabor to detect or manufacture
ambiguity where the language reveals none.” Franczyk v. Home Depot, Inc., 292 A.3d
852, 856 n.17 (Pa. 2023) (quoting Sivick v. State Ethics Comm’n, 238 A.3d 1250, 1265
(Pa. 2020)). To this end, “[w]hen the words of a statute are free and clear of all ambiguity,
we cannot disregard the letter of the statute under the pretext of pursuing its spirit.”
Fletcher v. Pa. Prop. & Cas. Ins. Guar. Ass’n, 985 A.2d 678, 684 (Pa. 2009) (citing 1
Pa.C.S. § 1921(b)). In this vein, when interpretating a statute “[w]ords and phrases shall
be construed according to rules of grammar and according to their common and approved
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 9 usage; but technical words and phrases and such others as have acquired a peculiar and
appropriate meaning or are defined in this part, shall be construed according to such
peculiar and appropriate meaning or definition.” 1 Pa.C.S. § 1903(a); see also Centolanza
v. Lehigh Valley Dairies, Inc., 658 A.2d 336, 340 (Pa. 1995) (“Absent a definition in the
statute, statutes are presumed to employ words in their popular and plain everyday sense,
and the popular meaning of such words must prevail.”).
Additionally, we “interpret statutory language not in isolation but with reference to
the context in which it appears” and “do not dissect statutory text and interpret it in a
vacuum.” Schmidt, 333 A.3d at 318 (quoting Commonwealth v. Kingston, 143 A.3d 917,
922, 924 (Pa. 2016)). To this end, “where the legislature includes specific language in
one section of the statute and excludes it from another the language should not be implied
where excluded.” Fletcher, 985 A.2d at 684. Likewise, where a section of a statute
contains a given provision, the omission of such a provision from a similar section is
significant to show a different legislative intent. Fonner v. Shandon, Inc., 724 A.2d 903,
907 (Pa. 1999). Further, “[e]very statute shall be construed, if possible, to give effect to
all its provisions,” 1 Pa.C.S. § 1921(a), and, therefore, “interpreting language as mere
surplusage is disfavored.” Jackiw v. Soft Pretzel Franchise (Workers’ Comp. Appeal Bd.),
329 A.3d 1152, 1156 (Pa. 2025); see also 1 Pa.C.S.§ 1922(2) (directing a presumption
“[t]hat the General Assembly intends the entire statute to be effective and certain”).
Specifically with respect to the WCA, “we have recognized that it ‘is remedial in nature
and is intended to benefit workers,’” and, therefore, it “must be liberally construed in order
to effectuate its humanitarian objectives.” Schmidt, 333 A.3d at 318 (quoting Martin v.
Workers’ Comp. Appeal Bd. (Emmaus Bakery), 652 A.2d 1301, 1303 (Pa. 1995)).
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 10 To answer the question before us we must interpret the Anti-Referral Provision of
the WCA. We begin our analysis, as required by the Statutory Construction Act, with the
Anti-Referral Provision’s plain language:
Notwithstanding any other provision of law, it is unlawful for a provider to refer a person for laboratory, physical therapy, rehabilitation, chiropractic, radiation oncology, psychometric, home infusion therapy or diagnostic imaging, goods or services pursuant to this section if the provider has a financial interest with the person or in the entity that receives the referral. It is unlawful for a provider to enter into an arrangement or scheme such as a cross-referral arrangement, which the provider knows or should know has a principal purpose of assuring referrals by the provider to a particular entity which, if the provider directly made referrals to such entity, would be in violation of this section. No claim for payment shall be presented by an entity to any individual, third-party payer or other entity for a service furnished pursuant to a referral prohibited under this section. 77 P.S. § 531(3)(iii). Precisely, we must determine whether the statute’s prohibition on
self-referrals is limited to the eight enumerated categories of services or whether, as the
courts below determined, the phrase “goods or services” is an independent catchall
category that brings other unenumerated categories, such as prescription drugs and
professional pharmaceutical services, within the provision’s scope.
The Commonwealth Court adopted its prior determination in Bennett that the Anti-
Referral Provision could be read as “it is unlawful for a provider to refer a person for …
goods or services.” 700 Pharmacy, 3315 A.3d at 925 (quoting Bennett, 306 A.3d at 959).9
This interpretation may appear reasonable if the phrase “goods or services” is read in
isolation. We do not, however, interpret statutory language in isolation, but rather “with
reference to the context in which it appears.” Schmidt, 333 A.3d at 318 (quoting Kingston,
143 A.3d at 922). When read within the context of the Anti-Referral Provision as a whole,
the unreasonableness of the court’s reading becomes clear because it ignores the
9 In discussing Bennett, the Commonwealth Court acknowledged that the precise question of the interpretation of “goods or services” was not before the court in that case. 700 Pharmacy, 315 A.3d at 925.
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 11 enumerated services that proceed “goods or services.” 10 The proper reading of the Anti-
Referral Provision’s plain language is that the phrase “goods or services” modifies the
enumerated medical services such that it is necessary to read “goods or services” after
each enumerated service, i.e. “it is unlawful for a provider to refer a person for laboratory
… goods or services pursuant to this section[;]” “it is unlawful for a provider to refer a
person for physical therapy … goods or services pursuant to this section[;]” “it is unlawful
for a provider to refer a person for rehabilitation … goods or services pursuant to this
section;” etc. This is the only interpretation that gives effect to the entirety of the Anti-
Referral Provision. See Pa.C.S. § 1921(a). Thus, the plain language of the statute makes
clear the General Assembly did not intend for “goods or services” to be a catchall category
bringing non-enumerated medical services within the Anti-Referral Provision’s prohibition
on self-referrals. An ejusdem generis analysis is, therefore, unnecessary.
This interpretation is supported by the Anti-Referral Provision’s structure. The
pertinent part of the provision reads “it is unlawful for a provider to refer a person for
10 The Commonwealth Court found “goods or services” to be a catchall category and then
applied an ejusdem generis analysis to “find that the enumerated items are wide-ranging topics across medical disciplines” that “are all medical in nature, and drugs and pharmaceutical services fall within the same general nature or class as those enumerated.” 700 Pharmacy, 315 A.3d at 925 (internal quotations omitted). With this interpretation the court attempted to limit the definition of “goods or services” by acknowledging the proceeding enumerated services. In Justice McCaffery’s interpretation, however, there is no such limitation. His dissent finds the phrase “goods or services” “unambiguously refers to all goods and services in which the provider has a financial interest.” Dis. Op. at 4 (McCaffery, J.) (emphasis in original). Likewise, Justice Wecht interprets the phrase “goods or services” to represent two additional distinct categories of prohibited self-referrals. Dis. Op. at 5 (Wecht, J.) These interpretations completely ignore the General Assembly’s inclusion of the enumerated services, rendering them absolutely meaningless, in clear violation of the Statutory Construction Act. See 1 Pa.C.S. § 1921(a) (“[e]very statute shall be construed, if possible, to give effect to all its provisions.”). Justice Wecht concedes that “under [his] interpretation, the legislature did not need to include the first eight examples of prohibited self-referrals in the statute.” Dis. Op. at 6 (Wecht, J.). The legislature, however, did include the enumerated prohibited self-referrals and that inclusion must mean something.
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 12 laboratory, physical therapy, rehabilitation, chiropractic, radiation oncology,
psychometric, home infusion therapy or diagnostic imaging, goods or services pursuant
to this section[.]” 77 P.S. § 531(3)(iii) (emphasis added). Recently in Coleman v.
Parkland School District, 346 A.3d 1266 (Pa. 2025), we interpreted Subsection 712.1(a)
of the Sunshine Act 11, which states “[e]xcept as provided in subsection (b), (c), (d), or (e),
an agency may not take official action on a matter of agency business at a meeting if the
matter was not included in the” Sunshine Act’s notification requirements. 66 Pa.C.S.
§ 712.1(a) (emphasis added). The Commonwealth Court had held that Subsection
712.1(a) had created only three independent notice exceptions and that Subsection
712.1(e) was a procedural mechanism, finding that if Subsection 712.1(e) was “treated
as a standalone exception, it would swallow the entire rule that the agency shall post the
agenda 24 hours in advance of a meeting.” Coleman, 346 A.3d at 1271. In reversing the
lower court, we stated:
Utilizing its plain disjunctive meaning, the use of the term “or” in this context indicates that there are four exceptions to the prohibition set forth in subsections (b) through (e). See In re Paulmier, 937 A.2d 364, 373 (Pa. 2007), as clarified (Dec. 28, 2007) (stating that the word “or” is a conjunction that is used to connect words, phrases, or clauses representing alternatives” and therefore, is “disjunctive” because it “means one or the other of two or more alternatives”); see also Or, WEBSTER’S II DICTIONARY (3d ed. 2005) (stating the term “or” is used “to indicate … [a]n alternative”). Id. (footnote omitted). Giving “or” its common definition, we found “[S]ubsection 712.1(a)
plainly sets the stage for the rest of Section 712.1, where we expect to find four exceptions
delineated in subsections (b) through (e), not one exception divided into four parts or
three exceptions and a procedural mechanism.” Id.
11 65 Pa.C.S §§ 701-716.
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 13 Giving the term “or” between “home infusion therapy” and “diagnostic imaging” the
same common disjunctive definition, see Pa.C.S. § 1903(a), indicates that the
enumerated services constitute a list of eight alternative services for which providers are
prohibited from providing self-referrals and not eight alternative services followed by an
additional catchall category. In the context of the Self-Referral Provision, the enumerated
services amount to a list of alternatives that together are modified by the phrase “goods
or services.” If, instead, the General Assembly intended “goods or services” to be
included in that list, it would have placed the “or” between “diagnostic imaging” and “goods
or services,” thus creating a list of nine alternative categories of prohibited self-referrals. 12
The Insurer agrees that the plain language of the Anti-Referral Provision controls
but nevertheless contends that our holdings in Schmidt and Eighty-Four Mining demand
an alternative interpretation. 13 In Schmidt we were tasked with determining whether CBD
oil prescribed to a claimant by a health care provider was included in the meaning of the
phrase “medicines and supplies” in Section 306(f.1)(i) of the WCA, see 77 P.S. § 531(1)(i).
As part of our analysis, we noted “our previous recognition that the WCA ‘clearly and
unambiguously provides that employers and insurers are obligated to pay providers …
12 In his dissent Justice Wecht criticizes us for supposedly disregarding the comma before
“goods or services,” in support of his determination that the Anti-Referral Provision contains ten distinct prohibitions. However, in addition to this interpretation requiring the insertion of a comma the legislature did not include, see Dis. Op. at 4 (Wecht, J.), it also requires the deletion of the “or” between “home infusion therapy” and “diagnostic imaging.” The inclusion of that “or” indicates the General Assembly intended to create a list of eight prohibited self-referrals. If, as Justice Wecht insists, the legislature intended to create a list of ten prohibited self-referrals, the inclusion of that “or” does not make any sense. Thus, Justice Wecht’s interpretation requires the Court to add a comma between “goods” and “services,” delete the “or” between “home infusion therapy” and “diagnostic imaging,” and conclude the legislature included the eight enumerated categories of self- referrals for absolutely no reason. 13 The Insurance Federation of Pennsylvania, American Property Casualty Insurance
Association, and Pennsylvania Defense Institute filed an amicus curiae brief in support of the Insurer.
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 14 for reasonable and necessary treatment or services connected to claimants’ work-related
injuries.’” Schmidt, 333 A.3d at 319 (quoting Keystone RX LLC v. Bureau of Workers’
Comp. Fee Rev. Hearing Off., 265 A.3d 322, 332 (Pa. 2021)) (emphasis and ellipses in
original). We continued:
It appears that we have viewed Section 306(f.1)(1) as the defining provision of employers’ and insurers’ responsibilities regarding payment of medical expenses for certain treatment and services – i.e., those that are reasonable and necessary to a claimant’s work-related injury. Accordingly, we do not limit our construction of Section 306(f.1)(1) to the individual terms “medicines” and “supplies.” Rather, in so construing, we give effect to “medicines and supplies” as provided in the statute as the broad- encompassing phrase intended by the General Assembly, evinced by the plain language thereof. Id. We therefore construed “medicines and supplies” as “any item that is part of a health
care provider’s treatment plan for a work-related-injury.” Id. at 329-330. We held this
definition includes CBD oil prescribed by a treating physician as part of a claimant’s
treatment plan.
According to the Insurer, our analysis in Schmidt “demonstrates the importance of
looking to prior cases in which the legislative intent of the text was discussed when the
meaning of statutory text is at issue[,]” and that “[i]f the noted legislative intent supports a
plain language reading of the statutory text … the statute will be declared unambiguous.”
Appellee’s Brief at 15-16. To this end, the Insurer turns to our opinion in Eighty-Four
Mining. The issue before the Court in that case was whether the Anti-Referral Provision
precluded payment for in-office physical therapy prescribed by a physician and performed
by a therapist employed by the physician’s professional corporation.
We began our analysis by noting that the Anti-Referral Provision was included in
the then-recent Act 44 WCA amendments and was “a medical cost containment
provision.” Eighty-Four Mining, 721 A.2d at 1063. While referrals for physical therapy
are unambiguously within the Anti-Referral Provision’s ban, we observed that “[n]either
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 15 the terms of th[e] Anti-Referral Provision nor the [WCA], in its entirety, [were] clear about
whether the ban on physician self-referrals included physician prescriptions for in-office
physical therapy.” Id. To answer that question we turned to a notice the Department
published to give instructions on its interpretation of the Anti-Referral Provision. 14 The
notice indicated the Department’s intention to incorporate the present and future federal
Safe Harbor regulations and exceptions to the Stark amendments and that “[a]n employer
or an insurer will not deny payment to a health care provider involved in a transaction or
referral that meets the incorporated Federal exceptions[.]” Id. at 1064 (quoting 23 Pa.
Bull. 4188 (Aug. 28, 1993)). At the time the notice was published those federal exceptions
included an exception for “in-office ancillary services.” Id. at 1065 (citing 42 U.S.C.
§ 1395nn(b)(2)). We concluded that the referral for in-office physical therapy satisfied the
in-office ancillary services exception and was resultingly excluded from the Anti-Referral
Provision’s ban on self-referrals.
The Insurer, similarly to Justice McCaffery’s dissent, latches on to our statements
in Eighty-Four Mining that the Anti-Referral Provision “is a medical cost containment
provision” and that the intent of the provision “was to contain costs by preventing
physicians from acting in their own self-interest.” Id. at 1063, 1067. Relying on these
statements, the Insurer asserts “it is undeniable that the legislative intent of the [A]nti-
[R]eferral [P]rovision is to contain medical costs by preventing physicians from self-
dealing in the workers’ compensation arena.” Appellee’s Brief at 18. The Insurer
14 The Department published the notice to “provide[ ] guidance to Department staff, employers, employes, insurers and other interested parties. Its aim [was] to facilitate the implementation of the recent amendments to the Act. Th[e] notice [did] not constitute a rule or regulation with the force or effect of law. Rather, it [was] temporary in nature. The Department intend[ed] to promulgate regulations to implement Act 44 as soon as possible.” Eighty-Four Mining, 721 A.2d at 1064 (quoting 23 Pa. Bull. 4185 (Aug. 28, 1993)). The Department subsequently promulgated regulations implementing Act 44’s amendments, including the Anti-Referral Provision.
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 16 therefore asserts we “should construe ‘goods or services’ as a broad-encompassing
phrase, intended by the General Assembly, evinced by the plain language thereof, just
as [we] did with the statutory text in question, also under Section 306 of the [WCA], in
Schmidt.” Id. at 18-19. According to the Insurer, “[b]anning prescription drugs and
professional pharmaceutical services self-referrals fully comports with the stated
legislative intent and interpreting the [A]nti-[R]eferral [P]rovision through this type of plain
language contextual analysis is consistent with the rules of statutory construction.” Id. at
19.
The Insurer’s reliance on Schmidt and Eighty-Four Mining is misplaced. As
explained above, “[t]he object of all interpretation and construction of statutes is to
ascertain and effectuate the intention of the General Assembly.” 1 Pa.C.S. § 1921(a).
“When the words of the statute are clear and free from all ambiguity, the letter of it is not
to be disregarded under the pretext of pursuing its spirit.” 1 Pa.C.S. § 1921(b); see also
Miller, 143 A.3d at 922 (“A statute’s plain language generally provides the best indication
of legislative intent.” (internal citation omitted)). Only when the plain language of the
statute is not explicit may we consider other matters to ascertain the legislature’s intent,
including the mischief to be remedied and the object to be attained. 1 Pa.C.S.
§ 1921(c)(3), (4).
Nothing in Schmidt altered these bedrock principles of statutory construction.
Rather, in Schmidt we recognized that we had viewed Section 306(f.1)(1) as “the defining
provision of employers’ and insurer’s responsibilities regarding payment of medical
expenses” that “are reasonable and necessary to a claimant’s work-related injury.”
Schmidt, 333 A.3d at 319. That recognition of our prior interpretation of Section
306(f.1)(1), however, did not require us to disregard the plain language of the Act in order
to pursue its spirit. See 1 Pa.C.S. § 1921(b). Instead, in construing the statute, we gave
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 17 “effect to ‘medicines and supplies’ as provided in the statute as the broad-based
encompassing phrase intended by the General Assembly, evinced by the plain
language thereof.” Schmidt, 333 A.3d at 319. (emphasis added). In other words,
irrespective of our prior determinations of the General Assembly’s intent in enacting
Section 306(f.1)(1), our holding in Schmidt was supported by the plain language of the
statute.
Similarly, notwithstanding our prior observations in Eighty-Four Mining regarding
the General Assembly’s intent in enacting the Anti-Referral Provision, we are required to
look to the statute’s plain language in interpreting the provision. We cannot ignore the
statute’s plain language in pursuit of its spirit. 1 Pa.C.S § 1921(b). The general intent of
the General Assembly in enacting the Anti-Referral Provision may have been to “contain
costs by preventing physicians from acting in their own self-interest.” Eighty-Four Mining,
721 A.2d at 1067. Recognition of that general intent, however, does not alter the plain
language the General Assembly used in the Act. Nor does it necessarily mean the
General Assembly barred treating physicians from making self-referrals for every possible
type of service. Justice McCaffery criticizes this conclusion, finding that the inclusion of
“goods or services” “means just that – all possible goods and services.” Dis. Op. at 6
(McCaffery, J.). As explained above, however, this conclusion requires us to ignore the
General Assembly’s inclusion of the eight enumerated services along with the Anti-
Referral Provision’s grammatical structure. Essentially, Justice McCaffery, along with the
Insurer, would have us ignore the plain language the legislature employed in pursuit of
the Eighty-Three Mining Court’s judicial determination of the legislature’s intent. That
intent is best evinced by the Anti-Referral Provision’s plain language that clearly limits the
prohibition on self-referrals to referrals for the eight enumerated services, which do not
include prescription drugs and professional pharmaceutical services.
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 18 Additionally, the Insurer’s alternative interpretation of “goods or services” is so
overly broad that it encompasses each and every one of the Anti-Referral Provision’s
specifically enumerated medical services. Not only would prescription drugs and
pharmaceutical services fit within the Insurer’s reading of “goods or services,” but so
would laboratory goods and services, physical therapy goods and services, rehabilitation
goods and services, and the rest of the Anti-Referral Provision’s enumerated medical
services. Such an interpretation would render those enumerated services mere
surplusage in contravention of our rules of statutory interpretation. See Jackiw, 329 A.3d
at 1156 (stating “interpreting language as mere surplusage is disfavored.”). If the General
Assembly intended “goods or services” to be read as broadly as the Insurer or the
dissents contend there would have been no need to list the enumerated medical services.
Likewise, Justice Wecht concedes that pursuant to his interpretation, “the legislature did
not need to include the first eight examples of prohibited self-referrals in the [Anti-Referral
Provision].” Dis. Op. at 6 (Wecht, J.). Justice Wecht acknowledges it is “somewhat odd
for the General Assembly to engage in surplusage” but that “oddity alone does not justify
ignoring the [A[nti-[R]eferral provision’s punctuation,” and that the Statutory Construction
Act states only that courts should give effect to all provisions of a statute “if possible.” Id.
at 7. As explained above, giving effect to all provisions of the Anti-Referral Provision is
not only possible but is also supported by the text of the statute, including the inclusion of
“or” between “infusion therapy” and “diagnostic imaging.” 15 If the interpretations proposed
by the Insurer and the respective dissents were correct the legislature would have simply
15 Justice Wecht also criticizes us for not applying the last antecedent rule.Dis. Op. at 7 (Wecht, J.). Justice Wecht himself also recognizes that this rule “is not absolute and may ‘be overcome by other indicia of meaning[.]” Dis. Op. at 7 (Wecht, J.) (quoting Barnhart v. Thomas, 540 U.S. 20, 26 (2003)). We believe the entirety of the content of the Anti- Referral Provision, as previously explained, clearly overcomes any application of the last antecedent rule.
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 19 stated “it is unlawful for a provider to refer a person for any goods or services.” The
legislature did not say that and instead listed eight enumerated categories of prohibited
self-referrals. Our interpretation is the only one that gives meaning to the language the
legislature actually used.
Other provisions of Section 306(f.1)(3) support our interpretation that self-referrals
for prescription drugs and professional pharmaceutical services are not included in the
Anti-Referral Provision’s ban. Two paragraphs after the Anti-Referral Provision, the
General Assembly enacted Section 306(f.1)(3)(vi), see 77 P.S. § 531(3)(vi), which
specifically and exclusively addresses prescription drugs and pharmaceutical services in
discussing reimbursement. We have previously stated that “where the legislature
includes specific language in one section of the statute and excludes it from another the
language should not be implied where excluded.” Fletcher, 985 A.2d at 684. More so, “it
is not for the courts to add, by interpretation, to a statute, a requirement which the
legislature did not see fit to include.” Shafer Elect. & Const. v. Mantia, 96 A.3d 989, 994
(Pa. 2014). Here, the legislature included specific language regarding the reimbursement
for drugs and professional pharmaceutical services in Section 306(f.1)(3)(vi) but failed to
include similar language in the Anti-Referral Provision prohibiting physician self-referrals
for such services. The omission of language regarding prescription drugs and
professional pharmaceutical services in the Anti-Referral Provision while including such
language in the provision addressing reimbursement is significant to show the General
Assembly did not intend to include prescription drugs and professional pharmaceutical
services in the Anti-Referral Provision’s self-referral prohibition. See Fonner, 724 A.2d at
907. We therefore decline to add such a self-referral prohibition through interpretation or
implication where the General Assembly declined, for whatever reason, to include one in
the statute’s plain language.
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 20 The Insurer contends Section 306(f.1)(3)(vi) is of no relevance to our interpretation
of the Anti-Referral Provision. It argues that in Schmidt we reiterated that Section
306(f.1)(1) was “the defining provision of employers’ and insurers’ responsibilities
regarding payment of medical expenses for certain treatments and services – i.e., those
that are reasonable and necessary to a claimant’s work-related injury.” Appellee’s Brief
at 32-33 (quoting Schmidt, 333 A.3d at 319). Consequently, the Insurer contends, “it is
logical that the legislature would draft subsequent provisions inclusively extending to
prescription drugs and pharmaceutical services as both are required to meet the proper
standard of care for treating work-related injuries” and “the fact that a subsequent
provision speaks to procedures concerning prescription drugs and pharmaceutical
services has no bearing on whether same are subject to the [A]nti-[R]eferral [P]rovision
in light of the broad-encompassing phrase “goods or services[.]” Id. at 33.
We agree that the legislature’s inclusion of a subsection in the WCA for the
reimbursement of prescription drugs and pharmaceutical services does not automatically
indicate the legislature did not also include those services in the Anti-Referral Provision.
However, the fact remains that when the legislature wanted to specifically address
prescription drugs and pharmaceutical services in the WCA it did so explicitly but failed
to include that explicit language in the Anti-Referral Provision. As we stated above “where
the legislature includes specific language in one section of the statute and excludes it
from another the language should not be implied where excluded.” Fletcher, 985 A.2d at
684. Under these circumstances, we find the General Assembly’s decision to include
prescription drugs and pharmaceutical services in Section 306(f.1)(3)(vi) but omit those
services from the Anti-Referral Provision supports our conclusion that those services are
not included in the Anti-Referral Provision’s self-referral prohibition.
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 21 Having found the Anti-Referral Provision’s plain language makes clear that the
phrase “goods or services” is not an independent catchall provision, we do not consider
the Department’s regulations in ascertaining the legislature’s intent. See 1 Pa.C.S. §
1921(c)(8) (“When the words of a statute are not explicit, the intention of the General
Assembly may be ascertained by considering, among other matters: Legislative and
administrative interpretations of such statute.”). That being the case, as the hearing
officer relied on the Department’s regulations in support of his determination, we observe
that those regulations are consistent with our interpretation. According to the regulations,
under the Anti-Referral Provision, “a provider may not refer a person for certain treatment
and services if the provider has a financial interest with the person or in the entity that
receives the referral.” 34 Pa. Code § 127.301(a) (emphasis added). In accordance with
our interpretation, the “certain” services are simply limited to the eight specific services
enumerated in the Anti-Referral Provision.
Furthermore, and contrary to the hearing officer’s reasoning, Section 301(c) of the
regulations is also consistent with our interpretation. Section 301(c) states in relevant
part “[r]eferrals permitted under all present and future Safe Harbor regulations
promulgated under [the Medicare Act] …, and all present and future exceptions to the
Stark amendments to the Medicare Act …, and all present and future regulations
promulgated thereunder are not prohibited referrals involving financial interest …” 34 Pa.
Code § 127.301(c) (emphasis added). The hearing officer accurately observed that
“outpatient prescriptions currently find no safe harbor” and “are explicitly disallowed”
under the Stark amendments. Hearing Officer Decision, Conclusions of Law, ¶ 4. The
hearing officer was correct that, unlike the Anti-Referral Provision, the Stark amendments
explicitly include outpatient prescription drugs as DHS for which providers are prohibited
from making self-referrals, see 42 U.S.C. § 1395nn(h)(6), and that outpatient
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 22 prescriptions drugs are not included in any of the Stark amendments’ exceptions or safe
harbors. See 42 U.S.C. § 1395nn(b). While the regulations incorporate those exceptions
and safe harbors, they do not purport to incorporate the Stark amendments’ list of DHS
that providers are prohibited from self-referring. Therefore, the fact that the Stark
amendments prohibit self-referrals for outpatient prescription services is of no relevance
in determining if the Department’s regulations include such a prohibition. Of even more
import is the fact that the text of the Anti-Referral Provision itself is completely bereft of
any indication that the General Assembly intended to incorporate the Stark amendments’
list of DHS. Moreover, as the plain language of the Anti-Referral Provision limits its
prohibition on self-referrals to the enumerated services, any attempt by the Department
to expand that prohibition to encompass additional services, including those listed in the
Stark amendments, would be clearly erroneous and inconsistent with the statute, entitling
it to little, if any, weight. See Lancaster Cnty. v. Pa. Labor Relations Bd., 124 A.3d 1269,
1286 (Pa. 2015).
Contrary to Justice McCaffery’s assertion in his dissent, our interpretation does not
embolden medical providers to prescribe unnecessary or harmful medication for
pecuniary gain or to commit any other nefarious actions. See Dis. Op. at 4 (McCaffery,
J.). Our interpretation simply gives meaning to the plain language the General Assembly
used in the Anti-Referral Provision. If our legislature, like the dissents, wishes to bring
self-referrals for prescription drugs and pharmaceutical services, or any other type of
service not enumerated in the Anti-Referral Provision, within the provision’s self-referral
prohibition, it is free to do so. Our interpretation merely recognizes it has so far failed to
bar such referrals. For the foregoing reasons, we reverse the Commonwealth Court and
remand the consolidated cases for further proceedings in accordance with this decision.
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 23 Chief Justice Todd and Justices Donohue, Dougherty and Brobson join the opinion. Justice Wecht files a dissenting opinion. Justice McCaffery files a dissenting opinion.
[J-95A-2025, J-95B-2025, J-95C-2025, J-95D-2025 and J-95E-2025] - 24