“Goods or Services” as a Modifier: Pennsylvania Narrows the Workers’ Compensation Act’s Anti‑Self‑Referral Ban to Enumerated Categories

1. Introduction

In 700 Pharm. v. Bur of WC (State Workers' Ins. Fund) (Pa. June 16, 2026), the Supreme Court of Pennsylvania addressed the scope of the Workers’ Compensation Act’s anti-referral provision, 77 P.S. § 531(3)(iii). The consolidated appeals arose from Bureau of Workers’ Compensation fee review determinations (affirmed by the Commonwealth Court) involving 700 Pharmacy (Appellant) and the Bureau of Workers' Compensation Fee Review Hearing Office (State Workers' Insurance Fund) (Appellee).

Although the opinion text provided is Justice Wecht’s dissent, it describes the Majority’s holding and the interpretive dispute. The central question was how to read the statutory list prohibiting certain self-interested referrals—specifically whether the phrase goods or services operates as a broad, free-standing prohibition (potentially reaching, for example, prescription drugs), or instead merely modifies a preceding list of enumerated medical categories.

2. Summary of the Opinion

As characterized in the dissent, the Majority held that the anti-referral language in 77 P.S. § 531(3)(iii) unambiguously prohibits self-referrals only within eight specified categories (laboratory, physical therapy, rehabilitation, chiropractic, radiation oncology, psychometric, home infusion therapy, diagnostic imaging), and that the words goods or services modify those enumerated categories rather than creating additional stand-alone prohibitions.

Justice Wecht dissented, arguing that the Majority’s reading is untenable because it requires ignoring statutory punctuation (notably the comma before goods or services), conflicts with the “last antecedent” canon, and improperly insists on clarity while implicitly balancing competing interpretive canons. In the dissent’s view, at minimum the text is ambiguous; once ambiguity is acknowledged, legislative purpose and the 1993 cost-containment context support a broader reading aimed at preventing self-interested referrals.

3. Analysis

3.1. Precedents Cited

  • Starck v. Union Cent. Life Ins. Co., 19 A. 703 (Pa. 1890)
    The dissent uses Starck to illustrate the historical backdrop: older courts sometimes discounted punctuation because early legislative texts were often unpunctuated. Justice Wecht distinguishes that historical practice from modern Pennsylvania interpretive law, arguing that contemporary courts may and should treat punctuation as meaningful evidence of legislative intent—especially for statutes enacted after 1964.
  • Cash Am. Net of Nev., LLC v. Pa. Dept. of Banking, 8 A.3d 282 (Pa. 2010)
    Cited as an example of the Pennsylvania Supreme Court relying on comma placement to interpret statutory text. The dissent invokes Cash Am. to rebut any suggestion that punctuation is too flimsy to matter and to reinforce that punctuation can be a legitimate interpretive aid under Pennsylvania law.
  • Jackiw v. Soft Pretzel Franchise (W.C.A.B.), 329 A.3d 1152 (Pa. 2025)
    Quoted (through the Majority’s use of it, as reported in the dissent) for the rule against surplusage—i.e., the presumption that statutory provisions should be construed to give effect to all words if possible. The dissent accepts the canon’s relevance but argues it cannot justify ignoring punctuation or other grammar-based canons when the statutory text points in the opposite direction.
  • McGuire on behalf of Neidig v. City of Pittsburgh, 285 A.3d 887 (Pa. 2022)
    Cited to support the proposition that legislatures sometimes draft redundantly (“belt-and-suspenders” drafting). This undercuts the Majority’s heavy reliance on the anti-surplusage canon: redundancy may be inelegant, but it is not so extraordinary that courts may disregard other textual clues (like punctuation) to eliminate it.
  • Barnhart v. Thomas, 540 U.S. 20 (2003)
    Used for the “last antecedent” rule: a qualifying phrase at the end of a list ordinarily modifies only the immediately preceding item absent contrary intent. The dissent argues the Majority’s construction—treating goods or services as modifying every earlier item—sits uneasily with this grammar-based presumption.
  • Pa. Dept. of Banking v. NCAS of Del., LLC, 948 A.2d 752 (Pa. 2008)
    Cited to show Pennsylvania’s recognition of last-antecedent reasoning (“generally prevails” absent contrary purpose). Justice Wecht uses it to argue the Majority did not adequately justify displacing the canon.
  • Eighty-Four Min. Co. v. Three Rivers Rehabilitation, Inc., 721 A.2d 1061 (Pa. 1998)
    Cited for the anti-referral provision’s understood policy aim within 1993 cost-containment reforms: to prevent physicians/providers from acting in “their own self-interest” when making referrals. The dissent relies on Eighty-Four Min. as purpose evidence that (in an ambiguity posture) supports a broad construction of prohibited self-referral behavior.

3.2. Legal Reasoning

The dissent frames the interpretive conflict as a textbook collision among canons of construction:

  • Punctuation as text: The dissent argues the comma before goods or services indicates that goods and services are separate list items—not a trailing modifier that must be mentally reinserted after each enumerated service. In the dissent’s view, treating the phrase as a modifier requires being “comma blind,” i.e., functionally ignoring enacted punctuation.
  • Anti-surplusage: The Majority (as described) invokes 1 Pa.C.S. § 1921(a) to avoid reading the statute in a way that would render the enumerated categories redundant if “goods” and “services” were broad catch-alls. The dissent concedes redundancy may result but argues that redundancy is preferable to rewriting the statute’s grammar, and that the statutory directive is to give effect to all provisions “if possible”—not at the cost of disregarding contrary textual signals.
  • Last antecedent rule: The dissent argues that if a trailing qualifier exists, it ordinarily attaches to the last item (here, potentially “diagnostic imaging”), not the entire series. The Majority’s list-wide modification approach is portrayed as contrary to ordinary grammar absent strong contextual indicators.
  • Ambiguity and purpose: For Justice Wecht, the very need to “balance” punctuation, surplusage, and last-antecedent considerations demonstrates ambiguity. Once ambiguous, 1 Pa.C.S. § 1921(c)(1)-(8) invites consideration of purpose, mischief, and consequences—leading (in the dissent’s view) to a broader anti-self-referral rule aligned with the 1993 cost-containment objective.

A further methodological critique appears in the dissent’s closing: the Majority is said to have resolved the case on a theory not embraced by the parties’ briefing—because the appeal was “supposed to be” about whether prescription drugs are “goods,” not about whether “goods or services” is merely a modifier. That point, as presented, is less about statutory semantics and more about judicial restraint and the risks of sua sponte reframing.

3.3. Impact

If the Majority’s construction is controlling going forward (as described in the dissent), it has three likely effects on Pennsylvania workers’ compensation practice:

  • Narrower anti-referral enforcement: The prohibition would be confined to the enumerated medical categories (and their associated goods/services), potentially excluding referrals for other items—most notably the dispute flagged in the dissent: referrals connected to prescription drugs dispensed by pharmacies.
  • Incentive to litigate category boundaries: Future disputes may shift from “Is this a self-referral for ‘goods’?” to “Is this item properly characterized as part of ‘diagnostic imaging’ or ‘home infusion therapy,’ etc.?” The definitional edges of the enumerated categories become more outcome-determinative.
  • Statutory drafting signal: The decision spotlights punctuation and list structure as dispositive, while also demonstrating that the anti-surplusage canon can override other grammar-based tools. Legislators (and agency drafters) may respond with more explicit catch-all language or clearer serialization (including Oxford commas) to prevent interpretive narrowing.

4. Complex Concepts Simplified

  • Anti-referral provision (self-referral ban): A rule that prevents a provider from sending a patient to a business in which the provider has a financial stake (to reduce conflicts of interest and unnecessary costs).
  • Oxford (serial) comma: The comma before the final “and/or” in a list (e.g., “A, B, and C”). Its presence or absence can affect whether a final phrase is read as a separate item or as a modifier.
  • Rule against surplusage: Courts generally try to avoid interpretations that make statutory words redundant, on the assumption that legislatures do not add meaningless language.
  • Last antecedent rule: A grammar rule of legal interpretation: a modifier at the end of a list usually attaches only to the nearest preceding item unless context shows otherwise.
  • “Plain meaning” vs. ambiguity: Text is “plain” only if it yields a clear meaning when read with ordinary tools of interpretation (including punctuation and grammar). If multiple reasonable readings persist, the statute is ambiguous and courts may consider purpose and consequences.

5. Conclusion

This decision (as portrayed through Justice Wecht’s dissent) establishes a consequential interpretive rule for 77 P.S. § 531(3)(iii): the phrase goods or services is treated by the Majority as a modifier tied to the enumerated categories, not a broad, stand-alone prohibition that reaches referrals for any goods or services generally. The dissent challenges that approach as inconsistent with punctuation, the last antecedent canon, and—once ambiguity is acknowledged—the cost-containment purpose recognized in Eighty-Four Min. Co. v. Three Rivers Rehabilitation, Inc.

The broader significance is methodological: the case illustrates how outcomes in statutory interpretation can hinge on list structure, punctuation, and the court’s choice among competing canons—and how declaring “unambiguity” may be contested when the interpretive work requires discounting textual features that were actually enacted.