KEY TAKEAWAYS:

• The Pennsylvania Commonwealth Court has ruled that suppliers of medical goods are not health care providers according to the Pennsylvania Workers’ Compensation Act

• As a result, medical goods suppliers are not entitled to recourse via the Medical Fee Review process

• The decision should provide relief for employers and insurers, reducing the number of time-consuming Medical Fee Review hearings they may face

On March 16, 2026, the Pennsylvania Commonwealth Court ruled in Scomed Supply v. Hartford Accident & Indemnity Company and Sedgwick Claims Management Services that Scomed, a supplier of medical goods, is not a health care provider under the Pennsylvania Workers’ Compensation Act (the Act). Before reaching the Commonwealth Court, Scomed filed multiple Medical Fee Reviews for medical goods which had been repriced and paid by the carrier. The Medical Fee Review Section found that no additional payment was due to Scomed, and Scomed filed requests for hearing, which were assigned to Hearing Officer Colleen Pickens.

Before the hearing officer, the carrier argued that Scomed was not entitled to recourse through the Fee Review process because it was not a “health care provider” within the meaning of Section 306(f.1)(5) of the Act. Hearing Officer Pickens agreed, ruling that Scomed was not a health care provider, as it exclusively dispensed products and medical equipment, was not licensed in the Commonwealth to provide any health care services, and did not render any medical treatment. For these reasons, Scomed’s requests for hearing were dismissed on the grounds that Scomed is not a health care provider and is not entitled to participate in the Medical Fee Review process.

Scomed appealed to the Commonwealth Court, which ultimately affirmed Hearing Officer Pickens’s decision on March 16. The court specifically ruled that Scomed is not a health care provider as defined under Section 127.3 of the Act’s Medical Cost Containment Regulations or Section 109 of the Act, both of which require the provider to be licensed by the Commonwealth to provide health care services. The court held that Scomed is only licensed as a distributor of medical goods, not to provide health care services, and accordingly is not a health care provider.

Before the Commonwealth Court, Scomed advanced multiple arguments that it was a health care provider under the Act, pointing to its federal qualifications as a supplier for Medicare and arguing that any finding to the contrary is a public policy issue, leaving medical supply companies without any recourse to challenge payments under the Act. The court acknowledged this argument, but found that the definition of “health care provider” is clear within the Act and concerns of public policy must be addressed by the legislature, not the court. The court specifically found that Section 306(f.1)(5) of the Act had clear language which could not be construed to fit with Scomed’s argument.

Ultimately, the Commonwealth Court held that a “health care provider” must be licensed within the Commonwealth to provide health care services, meaning that entities such as Scomed, who primarily deal with the sale or distribution of goods which are readily available without prescription and through ordinary retailers like Amazon and Walmart, are not health care providers, and are not entitled to the Fee Review process.

Certainly, this is a favorable outcome for employers and insurers, many of whom deal with multiple Medical Fee Reviews filed by Scomed and other similar suppliers as a matter of course. In theory, this ruling should preclude further Medical Fee Reviews filed by Scomed and similar medical suppliers, and provide a basis for insurers to move for dismissal of any presently pending Medical Fee Review Hearing Requests. It is expected that Scomed will challenge the ruling and, until all appeals are exhausted, the currently-filed Medical Fee Review Hearing Requests will be placed on hold.

In Elite Care RX v. Premier Comp. Solutions, et al., the Pennsylvania Superior Court ruled that health care providers could pursue civil lawsuits against insurers for unpaid workers’ compensation bills. The Pennsylvania Supreme Court affirmed the ruling. However, part of the reasoning for the providers to seek recourse outside of the confines of the Act included additional common law and tort claims which were not addressed within the Act. The allegations in the civil action included fraud, civil conspiracy, and unjust enrichment, not only whether Elite Care RX was a health care provider or whether its bills had been timely and appropriately repriced under the terms of the Act. While it is possible that Scomed may pursue civil litigation over the payment of its bills, the facts of Elite Care RX are unique and may not be applicable to billing issues that would ordinarily have been addressed in the Medical Fee Review process.

This ruling leaves it unclear what, if any, recourse Scomed and other providers of medical goods have to challenge the payment of bills, but the Commonwealth Court has made it clear that the proper recourse is not through the Fee Review process.

If you have questions about this decision or other workers’ compensation issues, please contact:

• Ashley E. Moss
• Emily Knight
• Or another member of our Workers’ Compensation practice group