Limiting Pennsylvania Workers’ Compensation Anti-Referral Ban: “Goods or Services” Modifies Only Enumerated Categories

1. Introduction

Case: 700 Pharm. v. Bur of WC (State Workers' Ins. Fund) (consolidated appeals, Nos. 97–101 MAP 2024).
Court: Supreme Court of Pennsylvania (Middle District).
Date: June 16, 2026 (dissenting opinion by Justice Wecht; Majority Opinion authored by Justice Mundy is referenced in the dissent).
Posture: Appeals from Commonwealth Court orders (May 16, 2024) affirming Bureau of Workers’ Compensation Fee Review Hearing Office determinations (May 20, 2020).

The dispute centers on the Workers’ Compensation Act’s anti-referral rule, which bars medical providers from referring workers’ compensation patients to entities in which the provider has a financial interest. The contested statutory language is:

refer a person for laboratory, physical therapy, rehabilitation, chiropractic, radiation oncology, psychometric, home infusion therapy or diagnostic imaging, goods or services pursuant to this section if the provider has a financial interest with the person or in the entity that receives the referral. (77 P.S. § 531(3)(iii))

As described by Justice Wecht, the Majority construed the phrase “goods or services” as a modifier that must be read after each enumerated medical service (yielding eight categories of prohibited self-referrals), rather than as two additional, standalone prohibitions. The dissent argues that punctuation and grammar point to a broader ban that separately covers “goods” and “services,” producing a more expansive anti-self-referral regime.

2. Summary of the Opinion

The provided text is Justice Wecht’s dissent. In it, he challenges the Majority’s “plain language” conclusion and contends the Majority’s reading is only plausible by disregarding the statute’s comma before “goods or services.” The dissent’s core points are:

  • The Majority’s interpretation effectively treats “goods or services” as a qualifying phrase that modifies each listed item, yielding eight categories.
  • The dissent reads the punctuation to create ten prohibitions: the eight enumerated service categories plus two additional standalone categories—“goods” and “services.”
  • The dissent argues a statute cannot be “unambiguous” if the “proper reading” requires ignoring punctuation and violating the last antecedent rule.
  • Even if the broader reading creates surplusage (because “goods” and “services” could subsume the earlier items), the dissent maintains that surplusage avoidance is only a preference and must yield to punctuation, grammar, and statutory purpose.
  • Once ambiguity is admitted, legislative purpose—cost containment and preventing financially self-interested referrals—supports a broader construction.

3. Analysis

A. Precedents Cited

Justice Wecht grounds his critique in Pennsylvania statutory interpretation doctrine and several cited authorities that bear on punctuation, canons of construction, and legislative drafting.

1) Punctuation as interpretive evidence

  • Starck v. Union Cent. Life Ins. Co., 19 A. 703 (Pa. 1890)
    The dissent notes the historical practice that legislatures once did not punctuate statutes, supporting older judicial skepticism about punctuation. But Justice Wecht uses Starck mainly as a contrast: modern Pennsylvania law has changed.
  • Cash Am. Net of Nev., LLC v. Pa. Dept. of Banking, 8 A.3d 282 (Pa. 2010)
    Cited to show that the Pennsylvania Supreme Court has relied on comma placement to interpret statutory text, supporting the dissent’s insistence that punctuation is part of “plain meaning” analysis.

The dissent also relies on the Statutory Construction Act’s directive that punctuation may aid interpretation for statutes enacted after December 31, 1964: 1 Pa.C.S. § 1923(b). Because the anti-referral provision was enacted in 1993, Justice Wecht argues its punctuation should be treated as meaningful evidence of legislative intent.

2) Plain meaning, surplusage, and “if possible” harmonization

  • Jackiw v. Soft Pretzel Franchise (W.C.A.B.), 329 A.3d 1152 (Pa. 2025)
    Quoted in the dissent (via the Majority’s citation) for the principle, rooted in 1 Pa.C.S. § 1921(a), that courts should give effect to all statutory provisions “if possible.” Justice Wecht accepts the principle but disputes its primacy when it conflicts with punctuation, grammar, and purpose.
  • McGuire on behalf of Neidig v. City of Pittsburgh, 285 A.3d 887 (Pa. 2022)
    Used to normalize “belt-and-suspenders” legislative drafting—i.e., statutory redundancy can be intentional or at least common—undercutting the Majority’s surplusage-based argument.

3) The last antecedent rule and grammar-based interpretation

  • Barnhart v. Thomas, 540 U.S. 20 (2003)
    Cited for the classic formulation of the last antecedent rule: “referential and qualifying words and phrases” generally apply only to the last antecedent unless context indicates otherwise. Justice Wecht argues the Majority’s approach—applying “goods or services” back across the entire list—does not comport with this canon.
  • Pa. Dept. of Banking v. NCAS of Del., LLC, 948 A.2d 752 (Pa. 2008)
    Cited to reinforce that last-antecedent reasoning generally prevails absent contrary purpose. The dissent sees no sufficient textual signal to overcome it, especially given the comma placement.

4) Legislative purpose of the anti-referral ban

  • Eighty-Four Min. Co. v. Three Rivers Rehabilitation, Inc., 721 A.2d 1061 (Pa. 1998)
    Cited for the stated objective behind the 1993 reforms: broadly preventing providers from acting in self-interest when making referrals—an aim the dissent believes supports reading “goods” and “services” as broad, standalone categories.

B. Legal Reasoning

1) The central textual dispute: modifier vs. standalone list items

The dissent frames the Majority’s reading as follows: “goods or services” is not itself a separate prohibition; rather, it modifies each enumerated term—laboratory, physical therapy, rehabilitation, etc.—as if the statute read “laboratory goods or services,” “physical therapy goods or services,” and so on.

Justice Wecht rejects that approach as inconsistent with the statute’s punctuation. He argues the comma before “goods or services” indicates “goods” and “services” are simply the final two items in a list of prohibited referral targets. In his view, the list is not eight items but ten: eight specified clinical categories plus “goods” and “services.”

2) Punctuation is part of plain meaning

A key jurisprudential move in the dissent is to treat punctuation not as a secondary aid but as part of the statute’s “ordinary” textual meaning. Justice Wecht argues the Majority cannot coherently claim unambiguity while adopting a reading that depends on being “comma blind.” He also leans on Pennsylvania’s modern interpretive regime (via 1 Pa.C.S. § 1923(b)) to argue punctuation is fair game.

3) Surplusage: a preference, not a trump card

The Majority (as summarized by the dissent) uses the canon against surplusage to argue that treating “goods” and “services” as broad, freestanding prohibitions would make the preceding eight categories redundant. The dissent concedes redundancy is a real consequence of his reading, but insists that:

  • The rule is phrased as “give effect to all provisions if possible” (1 Pa.C.S. § 1921(a)), not as an absolute bar on redundancy.
  • Redundant drafting occurs in practice (McGuire on behalf of Neidig v. City of Pittsburgh).
  • Surplusage avoidance should not require courts to ignore punctuation and grammar.

The dissent’s analogy—barring “cats, dogs, and animals” from a building—illustrates his point that redundancy does not necessarily make a provision “ineffective”; it may merely reflect emphatic or cautious drafting.

4) Last antecedent and the “compound list item” point

Justice Wecht also critiques the Majority’s handling of “home infusion therapy or diagnostic imaging,” suggesting the Majority treats any “or” as signaling the end of a list item and the approach to list termination. The dissent rejects that as a matter of ordinary English usage, noting a list item can itself be compound (e.g., “Alaska or Hawaii” in a list).

On last antecedent, the dissent argues that if “goods or services” were a trailing qualifier, it would naturally attach to the nearest antecedent (arguably “diagnostic imaging”), not to all eight prior categories—unless there is strong contrary indication. The dissent sees the comma as pointing the other way: “goods” and “services” are not qualifiers at all.

5) Ambiguity and statutory purpose

Justice Wecht argues that the presence of competing canons (punctuation/grammar/last-antecedent vs. surplusage avoidance) itself signals ambiguity. Once ambiguity is acknowledged, the dissent would look to the interpretive factors in 1 Pa.C.S. § 1921(c)(1)-(8), including:

  • the occasion and necessity for the statute,
  • the circumstances under which it was enacted,
  • the mischief to be remedied, and
  • the consequences of a particular interpretation.

Using Eighty-Four Min. Co. v. Three Rivers Rehabilitation, Inc., the dissent ties the anti-referral ban to cost-containment and anti-self-dealing. Under that purpose-driven approach, a broad ban on self-referrals for “goods” and “services” is more consistent with the reform’s stated aims than a narrow list-driven prohibition.

C. Impact

1) Doctrinal impact: narrowing the anti-referral provision

As described, the Majority’s construction makes the anti-referral provision operate primarily as a targeted list of specified referral categories, rather than a broad prohibition reaching referrals for “goods” and “services” generally. This can materially narrow the statute’s reach depending on how certain referral types (including pharmacy dispensing) are categorized.

2) Practical impact on workers’ compensation medical commerce

The interpretive choice has direct consequences for business models and compliance, including:

  • Pharmacies and dispensing practices: The dissent notes the appeal was “supposed to be about” whether prescription drugs constitute “goods or services.” Under a narrow reading, parties may litigate whether pharmacy-related transactions fit within the enumerated categories.
  • Referral-driven vertical integration: A narrower list may leave more room for financially interested arrangements unless they fall squarely within a listed category or within the provision’s anti-circumvention clause (cross-referral schemes).
  • Fee review disputes: Because these cases arise from fee-review determinations, the decision may shape how hearing officers and the Commonwealth Court evaluate provider billing and referral relationships in future administrative disputes.

3) Interpretive impact: punctuation and “plain meaning” in Pennsylvania

The dissent highlights a broader methodological concern: whether a court may call a statute “unambiguous” while discounting punctuation and grammar-based canons. Even if nonbinding as a dissent, the opinion supplies a roadmap for future litigants seeking to:

  • press punctuation as part of textual meaning under 1 Pa.C.S. § 1923(b), and
  • argue that competing canons should trigger ambiguity analysis and resort to 1 Pa.C.S. § 1921(c) purpose factors.

4. Complex Concepts Simplified

  • Anti-referral / self-referral: A rule preventing a provider from sending a patient to a service or supplier the provider owns or profits from, to avoid conflicts of interest and unnecessary utilization.
  • Oxford (serial) comma: The comma before “and/or” in a list (e.g., “A, B, and C”). Its omission can create ambiguity. The dissent uses the concept to show how tiny drafting choices can change meaning.
  • Rule against surplusage: A preference that each statutory word should do some work—courts try to avoid readings that make text redundant.
  • Last antecedent rule: A grammar-based canon that a trailing modifier generally applies only to the closest preceding term, not to earlier items in a series, unless context clearly indicates otherwise.
  • Plain meaning vs. ambiguity: If text is “unambiguous,” courts typically apply it as written without considering external purpose factors. If “ambiguous,” courts may consider context, purpose, and consequences under 1 Pa.C.S. § 1921(c).

5. Conclusion

Justice Wecht’s dissent in 700 Pharm. v. Bur of WC (State Workers' Ins. Fund) is a forceful challenge to the Majority’s list-and-surplusage-driven interpretation of 77 P.S. § 531(3)(iii). The dissent’s principal contribution is methodological: it insists punctuation and ordinary grammar are integral to textual meaning and that courts should not declare “plain language” clarity while effectively rewriting a statute’s syntactic signals.

Substantively, the dispute concerns the scope of Pennsylvania’s workers’ compensation anti-referral rule—whether it is a narrow set of enumerated prohibitions (the Majority’s approach as described) or a broader ban that separately reaches referrals for “goods” and for “services” (the dissent’s approach). The interpretive choice has tangible consequences for cost-containment policy, provider conflicts of interest, and the legality of financially interested referral arrangements in the workers’ compensation system.