KEY TAKEAWAYS:

• On October 6, the Pennsylvania Supreme Court denied Scomed Supply’s Petition for Allowance of Appeal from the Commonwealth Court’s ruling that medical goods suppliers are not “health care providers” under the Pennsylvania Workers’ Compensation Act.

• The denial leaves the Commonwealth Court’s March 16 decision in place as the controlling law in Pennsylvania.

• Employers and insurers now have firm grounds to seek dismissal of pending Medical Fee Review Hearing Requests filed by Scomed and similar suppliers, and to oppose new ones.

On October 6, the Pennsylvania Supreme Court issued a per curiam order denying the Petition for Allowance of Appeal filed by Scomed Supply in Scomed Supply v. Hartford Accident & Indemnity Company and Sedgwick Claims Management Services (Bureau of Workers’ Compensation Fee Review Hearing Office), No. 300 MAL 2026. Scomed sought review of the Commonwealth Court’s order holding that it does not qualify as a health care provider under the Pennsylvania Workers’ Compensation Act.

As we reported in April, the Commonwealth Court held on March 16 that Section 109 of the Act and Section 127.3 of the Medical Cost Containment Regulations require a health care provider to hold a Commonwealth license to provide health care services. Because Scomed held a license only as a distributor of medical goods, it could not use the Medical Fee Review process to challenge the repricing of its bills, and the court left Scomed’s public policy concerns to the Legislature.

Scomed then asked the Pennsylvania Supreme Court to take up the case through a Petition for Allowance of Appeal, the discretionary mechanism by which a party requests Supreme Court review of a Commonwealth Court order. The Supreme Court denied the petition in a one-line per curiam order. Because review at this stage is discretionary, the denial does not amount to a ruling on the merits by the Supreme Court. Its practical effect, however, is significant: the Commonwealth Court’s decision stands, and Scomed has exhausted its avenues for review within the Pennsylvania court system.

For employers and insurers, the denial brings welcomed clarity. When the Commonwealth Court ruled in March, many anticipated that Scomed would seek further review and that pending Medical Fee Review Hearing Requests would remain on hold until the appeals concluded. That uncertainty has now largely been resolved. Carriers and their counsel should consider moving promptly to dismiss any pending Medical Fee Review Hearing Requests filed by Scomed and by other suppliers whose operations consist of selling or distributing goods without a Commonwealth license to provide health care services. The ruling should also support objections to any new Fee Review filings by such suppliers at the outset, sparing employers and insurers the time and expense of litigating those disputes through the hearing process.

Employers and insurers should still evaluate each supplier individually. The Commonwealth Court’s holding turns on licensure, so an entity that holds a Commonwealth license to provide health care services may still qualify as a health care provider entitled to Fee Review, even if it also supplies medical goods. Carriers should confirm a supplier’s licensure status before seeking dismissal.

The question of what recourse, if any, medical goods suppliers retain also remains open. In Elite Care RX v. Premier Comp. Solutions, et al., the Pennsylvania Superior Court allowed health care providers to pursue civil lawsuits against insurers over unpaid workers’ compensation bills, and the Pennsylvania Supreme Court affirmed. That case, however, involved common law and tort claims, including fraud, civil conspiracy, and unjust enrichment, that fell outside the Act. Scomed and similar suppliers may attempt to bring billing disputes into the civil courts, but the facts of Elite Care RX may not extend to ordinary repricing disputes that would otherwise proceed through Medical Fee Review. Employers and insurers should watch for any such filings.

Next Steps for Employers and Insurers

The Supreme Court’s denial cements the Commonwealth Court’s message: suppliers of medical goods that lack a Commonwealth license to provide health care services cannot use the Medical Fee Review process to challenge the payment of their bills. Employers and insurers should now act on that clarity. Carriers should identify every pending Medical Fee Review Hearing Request filed by Scomed or a similar supplier and work with counsel to file motions to dismiss, citing the Commonwealth Court’s decision and the Supreme Court’s October 6 order denying review. Where a hearing officer placed a matter on hold pending the appeal, carriers should ask that the matter be returned to the active docket and resolved promptly. Claims teams should also verify each supplier’s licensure status before contesting a new Fee Review filing, document the basis for any repricing decision, and keep billing files complete in case a supplier turns to civil litigation instead. Taking these steps now will help employers and insurers close out lingering Fee Review disputes and limit the cost of defending them.

If you have questions about how the Commonwealth Court’s decision impacts your business, please contact:

• Angela G. DiSanti
• Or another member of the firm’s Workers’ Compensation team