A Pennsylvania appellate court ruled that a distributor of Durable Medical Equipment (DME) does not qualify as a “healthcare provider” under the Workers’ Compensation Act and therefore cannot use the state’s medical fee review process to dispute reimbursement.

In Scomed Supply v. Hartford Accident & Indemnity Co., Scomed appealed a determination by the Workers’ Compensation Fee Review Office that it was not a “healthcare provider” under the Act and therefore lacked standing because it supplied medical products rather than medical care.

The court agreed with a prior decision that Scomed did not qualify as a healthcare provider, and rejected Scomed’s argument that its Medicare accreditation and role in patient care qualified it as a provider. For its decision, the court relied on prior case law that distinguishes medical suppliers from providers and characterizes such vendors as “middlemen.”

This case confirms that reimbursement disputes brought by medical supply vendors are not eligible for review by the Pennsylvania Bureau of Workers’ Compensation Fee Review Office. Where disputes arise, resolution is limited to contractual remedies, or through civil litigation. From a payer perspective, managing DME through network arrangements and prospective authorization can help reduce reimbursement disputes and strengthen defensibility of payment determinations.