The PA Supreme Court ruled favorably this past December in a crucial workers’ compensation case for which the PA Chamber had joined in an amicus “friend of the court” brief. The case involved the Workers’ Compensation Utilization Review (UR) process in which disagreements over medical treatment are resolved. This process involves the patient, treating healthcare professional and employer.
In Keystone RX v Bureau of Workers’ Compensation Fee Review Hearing Office, the PA Supreme Court held that a “non-treating provider,” like a pharmacy or medical equipment provider, does not have the right to intervene in the UR process. An unfavorable ruling would have represented a significant change to the UR process that was fraught with unanswered questions and the potential for complications, higher costs and more litigation.
This case also represents a chapter in the PA Chamber’s long-running efforts to combat price-gouging and abuse of the workers’ compensation system. In Keystone RX, the initial dispute concerned a tube of topical cream for which the pharmacy was seeking reimbursement of $3,500.
Similar circumstances were uncovered several years ago by the Philadelphia Inquirer. The paper ran an exposé detailing an arrangement in which the Pond Lehocky law firm directed workers’ compensation clients to specific doctors who prescribed topical compound creams with dubious legitimacy and then funneled the unsuspecting patients to pharmacies owned by the firm and doctors themselves.
According to the investigative reporter, “The pharmacy then charges employers or their insurance companies for the workers’ pain medicine, sometimes at sky-high prices.”
Several leading medical and legal ethics authorities denounced the firm, which ultimately divested from the pharmacy.
The PA Chamber was pleased with this recent Supreme Court decision and will continue to fight workers’ compensation abuse.