KEYSTONE RX v. BUREAU OF WORKERS' COMP.

Nos. 27 EAP 2020, 28 EAP 2020.

265 A.3d 322 (2021)

KEYSTONE RX LLC, v. BUREAU OF WORKERS' COMPENSATION FEE REVIEW HEARING OFFICE (Compservices Inc./AmeriHealth Casualty Services) Appeal of: Compservices/AmeriHealth Casualty Services Keystone RX LLC v. Bureau of Workers' Compensation Fee Review Hearing Office (Compservices Inc./AmeriHealth Casualty Services) Appeal of: Bureau of Workers' Compensation Fee Review Hearing Office.

Supreme Court of Pennsylvania.

Decided: December 22, 2021.


Attorney(s) appearing for the Case

Kimberly Dawn Mazin, Esq. , Philadelphia, Eric G. Preputnick, Esq. , Commonwealth of Pennsylvania, Deborah Jean Schwartz, Esq. , Pennsylvania Department of Labor & Industry, Harrisburg, Kelly Kathleen Smith, Esq. , for Bureau of Workers' Compensation Fee Review Hearing Office, Appellant.

Audrey Jacobsen Copeland, Esq. , King of Prussia, Marshall Dennehey Warner Coleman & Goggin, PC, for The Coalition Against Insurance Fraud, Appellant Amicus Curiae.

Steven Burgess Davis, Esq. , Philadelphia, for Insurance Federation of Pennsylvania, et al., Appellant Amicus Curiae.

Karl Stewart Myers, Esq. , Stradley, Ronon, Stevens & Young, LLP, Philadelphia, for Insurance Federation of Pennsylvania, et al., Appellant Amicus Curiae.

Michele R. Punturi, Esq. , Marshall Dennehey Warner Coleman & Goggin, Philadelphia, for The Coalition Against Insurance Fraud, Appellant Amicus Curiae.

Anthony J. Bilotti, Esq. , Anthony J. Bilotti & Associates, L.L.C., Media, for Compservices Inc./AmeriHealth Casualty Services, Appellee.

Jay Brandon Todd McCoy, Esq. , Anthony J. Bilotti & Associates, L.L.C., for Compservices Inc./AmeriHealth Casualty Services, Appellee.

Daniel Joel Siegel, Esq. , Law Offices of Daniel J. Siegel, L.L.C., Havertown, for Keystone Rx LLC, Appellee.

Karl Stewart Myers, Esq. , Stradley, Ronon, Stevens & Young, LLP, Philadelphia, for American Property Casualty Insurance Association, Amicus Curiae, Insurance Federation of Pennsylvania, et al., Appellant Amicus Curiae.

Anthony J. Bilotti, Esq. , Media, Jay Brandon Todd McCoy, Esq. , Anthony J. Bilotti & Associates, L.L.C., Compservices Inc./AmeriHealth Casualty Services, Appellant.

Audrey Jacobsen Copeland, Esq. , Marshall Dennehey Warner Coleman & Goggin, PC, King of Prussia, for The Coalition Against Insurance Fraud, Appellant Amicus Curiae.

Steven Burgess Davis, Esq. , Philadelphia, for Insurance Federation of Pennsylvania, et al., Appellant Amicus Curiae.

Shawn C. Gooden, Esq. , Weber Gallagher Simpson Stapleton Fires & Newby, LLP, Harrisburg, for Laundry Owners Mutual Liability Insurance Association, et al., Appellant Amicus Curiae.

Anthony Natale III, Esq. , Michele R. Punturi, Esq. , Marshall, Dennehey, Warner, Coleman & Goggin, P.C., Philadelphia, for The Coalition Against Insurance Fraud, Appellant Amicus Curiae.

Lori Anne Tunstall, Esq. , Weber Gallagher Simpson Stapleton Fires & Newby, LLP, Philadelphia, for Laundry Owners Mutual Liability Insurance Association, et al., Appellant Amicus Curiae.

Kimberly Dawn Mazin, Esq. , Philadelphia, Eric G. Preputnick, Esq. , Commonwealth of Pennsylvania, Bureau of Workers' Compensation Fee Review Hearing Office, Appellee, Deborah Jean Schwartz, Esq. , Pennsylvania Department of Labor & Industry, Harrisburg, for Bureau of Workers' Compensation Fee Review Hearing Office, Appellee.

Daniel Joel Siegel, Esq. , Law Offices of Daniel J. Siegel, L.L.C., Havertown, for Keystone Rx LLC, Appellee.

BAER, C.J., SAYLOR, TODD, DONOHUE, DOUGHERTY, WECHT, MUNDY, JJ.


OPINION

In this workers' compensation matter, the Bureau of Workers' Compensation Fee Review Hearing Office ("Hearing Office") concluded that, in the fee review setting, a non-treating healthcare provider, like a pharmacy, cannot challenge a utilization review ("UR") determination that medications...

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