“Goods or Services” as a Modifier, Not a Standalone Anti-Referral Ban Under 77 P.S. § 531(3)(iii)

1. Introduction

700 Pharm. v. Bur of WC (State Workers' Ins. Fund) (Pa. June 16, 2026) arises from multiple consolidated appeals (Nos. 97–101 MAP 2024) challenging fee-review determinations under the Workers’ Compensation system. The dispute centers on the scope of the Workers’ Compensation Act’s anti-referral provision, 77 P.S. § 531(3)(iii), which prohibits certain self-interested referrals by medical providers when the provider has a financial interest in the referral recipient.

Although the text provided is a dissenting opinion by Justice Wecht, it describes the Majority’s statutory holding: the Majority read the anti-referral list to contain eight prohibited referral categories, treating the phrase goods or services as a modifier that must be read after each enumerated medical service (e.g., “laboratory goods or services,” etc.), rather than as two additional standalone prohibitions.

The practical backdrop (as indicated in the dissent) involves whether pharmacy-related activity—particularly referrals/arrangements involving prescription drugs—falls within goods or services for purposes of the anti-referral ban. Justice Wecht emphasizes that the case, as briefed, was expected to focus on whether prescription drugs qualify as “goods,” but the Majority instead resolved a broader structural question: whether “goods or services” is independent or merely modifying.

2. Summary of the Opinion

Majority (as characterized in the dissent): The Court’s Majority concluded that the anti-referral provision is plain and unambiguous and prohibits only eight categories of self-referrals, because the phrase goods or services modifies each of the enumerated services (laboratory, physical therapy, rehabilitation, chiropractic, radiation oncology, psychometric, home infusion therapy, diagnostic imaging). Under this reading, “goods” and “services” are not separate broad catchall categories.

Dissent (Justice Wecht): Justice Wecht rejected the Majority’s “plain language” claim, arguing that the statute’s punctuation (notably, a comma before goods or services) and the last antecedent canon make the Majority’s reading at least debatable and likely wrong. He would read the text as creating ten distinct prohibitions, with “goods” and “services” as the final two list items—broad enough to cover, among other things, referrals involving prescription drugs. He further maintained that once ambiguity is acknowledged, statutory purpose—cost containment and preventing self-interested referrals— supports the broader reading.

3. Analysis

3.1 Precedents Cited

Punctuation as an interpretive aid (and its modern legitimacy)

  • Starck v. Union Cent. Life Ins. Co., 19 A. 703 (Pa. 1890): Justice Wecht invoked Starck to explain the historical hesitation to rely on punctuation in statutes—because older enactments were often unpunctuated. The dissent uses this history to frame why modern law differs and why punctuation is now fair game.
  • 1 Pa.C.S. § 1923(b): The dissent relies on the Statutory Construction Act’s express authorization to use punctuation to aid construction for statutes enacted after December 31, 1964—critically, the anti-referral provision was enacted in 1993—supporting the dissent’s view that the comma before “goods or services” is meaningful evidence of legislative intent.
  • Cash Am. Net of Nev., LLC v. Pa. Dept. of Banking, 8 A.3d 282 (Pa. 2010): Cited as an example of the Court relying on comma placement to interpret statutory text, reinforcing that punctuation can carry substantive interpretive weight in Pennsylvania.

Surplusage, “effect to all provisions,” and modern drafting realities

  • 1 Pa.C.S. § 1921(a): Both sides, as described, use the directive to construe statutes to give effect to all provisions “if possible.” The Majority used this to argue that treating “goods” and “services” as standalone would render the preceding enumerated services surplusage. The dissent accepts potential redundancy but contends it is not dispositive.
  • Jackiw v. Soft Pretzel Franchise (W.C.A.B.), 329 A.3d 1152 (Pa. 2025): Cited (by the Majority per the dissent) for statutory interpretation principles tied to § 1921(a), reinforcing the anti-surplusage impulse.
  • McGuire on behalf of Neidig v. City of Pittsburgh, 285 A.3d 887 (Pa. 2022): The dissent uses McGuire to normalize legislative “belt-and-suspenders” drafting—supporting the proposition that redundancy can occur and does not justify rewriting or ignoring other textual cues (like punctuation).

The last antecedent rule as a grammatical constraint

  • Barnhart v. Thomas, 540 U.S. 20 (2003): Justice Wecht relied on Barnhart for the canonical statement of the last antecedent rule: qualifying phrases at the end of a list typically refer only to the immediately preceding item absent contrary intent. Applied here, “goods or services” would most naturally modify only “diagnostic imaging,” not every earlier item—undercutting the Majority’s across-the-board modifier reading.
  • Pa. Dept. of Banking v. NCAS of Del., LLC, 948 A.2d 752 (Pa. 2008): Cited for the Pennsylvania articulation of last antecedent preference “in absence of evidence of some contrary purpose,” bolstering the dissent’s claim that the Majority’s interpretation conflicts with a familiar grammatical canon.

Statutory purpose and the anti-self-interest rationale

  • Eighty-Four Min. Co. v. Three Rivers Rehabilitation, Inc., 721 A.2d 1061 (Pa. 1998): The dissent uses Eighty-Four Min. Co. to identify the animating goal of the 1993 cost-containment reforms: broadly preventing providers from making referrals in their own financial self-interest. This purpose becomes central in the dissent’s argument once ambiguity is acknowledged.
  • 1 Pa.C.S. § 1921(c)(1)-(8): The dissent highlights that if text is ambiguous, courts may consider purpose-based factors (occasion/necessity, circumstances of enactment, mischief to be remedied, consequences). Justice Wecht argues the Majority’s narrow reading frustrates the mischief-remedying aim of the provision.

Secondary authority on punctuation and canons

  • ANTONIN SCALIA & BRYAN A. GARNER, READING LAW: THE INTERPRETATION OF LEGAL TEXTS: The dissent quotes this treatise for two propositions: (1) punctuation cannot be ignored in intelligent construction; and (2) a text cannot be deemed “clear” while disregarding punctuation. The treatise is also used to explain the Oxford comma’s role in reducing ambiguity.

3.2 Legal Reasoning

(A) The central grammatical dispute: list structure

The statutory phrase at issue prohibits a provider from referring a person for: laboratory, physical therapy, rehabilitation, chiropractic, radiation oncology, psychometric, home infusion therapy or diagnostic imaging, goods or services if the provider has a financial interest in the referral recipient.

The Majority’s approach (as described) treats goods or services as a trailing qualifier that attaches backward to each enumerated medical service, yielding eight categories in total. Justice Wecht’s dissent argues that the comma before goods or services indicates that “goods” and “services” are themselves list items—producing ten categories.

(B) Punctuation vs. anti-surplusage: competing canons

The dissent’s core methodological critique is that the Majority elevates the anti-surplusage canon to the point of overriding punctuation and other grammatical canons. Justice Wecht concedes that reading “goods” and “services” as standalone could make the prior enumerated services appear redundant; but he argues that redundancy is not unknown in legislative drafting and that § 1921(a) only requires giving effect to all provisions “if possible,” not at the cost of ignoring punctuation that the legislature actually enacted.

(C) The last antecedent rule as a check on expansive modification

Under the dissent’s analysis, even if “goods or services” were treated as a modifier (rather than separate items), the last antecedent rule would typically tie that modifier only to the immediately preceding phrase (most naturally “diagnostic imaging”). The Majority’s decision to apply the modifier to all earlier list items requires a justification strong enough to overcome this canon; the dissent finds the Majority’s explanation (surplusage avoidance) insufficient—especially while proclaiming unambiguity.

(D) Plain meaning vs. ambiguity: the dissent’s “threshold” objection

Justice Wecht’s dissent is also a “meta-interpretation” critique: he argues the statute cannot be labeled unambiguous if a “proper reading” requires disregarding a comma and choosing among competing canons. In his view, acknowledging ambiguity would naturally shift the inquiry to legislative purpose and consequences under § 1921(c), where broad anti-self-referral policy (as articulated in Eighty-Four Min. Co.) would support a broader reading.

3.3 Impact

Immediate doctrinal effect (Majority rule as described)

The Majority’s construction, as recounted in the dissent, narrows the anti-referral provision by treating goods or services as a dependent phrase rather than an independent catchall prohibition. In practical terms, the decision tends to confine enforcement to the enumerated service domains (laboratory, physical therapy, rehabilitation, chiropractic, radiation oncology, psychometric, home infusion therapy, diagnostic imaging), rather than extending the statute broadly to any financially interested referral for “goods” (like prescription drugs) or “services” more generally.

System-level consequences

  • Cost-containment tension: The dissent frames the 1993 reforms as aimed at suppressing self-interested referral behavior. A narrow reading may reduce the anti-referral provision’s reach in emerging or non-enumerated referral markets (including pharmacy-related arrangements), potentially shifting cost-containment burdens to other provisions, regulations, or payer controls.
  • Litigation incentives: By characterizing the statute as “unambiguous,” the Majority’s approach may discourage purpose-based arguments and compress future disputes into textual parsing of whether a referral fits within one of the enumerated categories (or whether the arrangement can be recharacterized as one of them).
  • Legislative drafting response: The dissent highlights how comma placement and list design can become outcome-determinative. The decision may spur legislative clarification—e.g., explicitly adding “pharmacy,” “prescription drugs,” or expressly stating whether “goods” and “services” are standalone categories.

4. Complex Concepts Simplified

  • Anti-referral (self-referral) rule: A restriction preventing a provider from steering patients to entities in which the provider has a financial stake, to avoid conflicts of interest and unnecessary services.
  • Oxford (serial) comma: The comma after the second-to-last item in a list (e.g., “A, B, and C”). Its presence or absence can affect whether items are grouped together or treated as separate.
  • Rule against surplusage: A canon advising that courts should avoid interpretations that make statutory words redundant—though it is a preference, not an absolute command, particularly when other textual indicators point the other way.
  • Last antecedent rule: A grammar-based canon stating that a qualifying phrase at the end of a list usually modifies only the nearest preceding item, unless context clearly indicates broader reach.
  • “Plain meaning” vs. “ambiguity”: If a statute is genuinely clear, courts generally apply it as written. If it is ambiguous, courts may consult additional tools (purpose, mischief, consequences) as listed in 1 Pa.C.S. § 1921(c).

5. Conclusion

As described in Justice Wecht’s dissent, 700 Pharm. v. Bur of WC (State Workers' Ins. Fund) establishes (for the Majority) a narrow, text-driven rule: the Workers’ Compensation Act’s anti-referral provision prohibits self-referrals only within the enumerated medical service domains, because goods or services functions as a modifier rather than an independent, general prohibition.

The dissent’s significance lies in its methodological warning: statutory “clarity” cannot be asserted while ignoring punctuation and grammatical canons like the last antecedent rule, and—once ambiguity is conceded—Pennsylvania’s interpretive framework invites attention to legislative purpose, especially the cost-containment and anti-conflict goals recognized in Eighty-Four Min. Co. v. Three Rivers Rehabilitation, Inc.. The decision thus becomes a notable marker in Pennsylvania statutory interpretation, illustrating how courts prioritize among competing canons and how list punctuation can shape the reach of regulatory prohibitions in the workers’ compensation system.