Justia Pennsylvania Supreme Court Opinion Summaries

In 2008, Attorney David Landay submitted to appellant Rite Aid of Pennsylvania, Inc., an "authorization" on behalf of an individual, requesting copies of the that person's pharmacy records. In response to the requests, Rite Aid sent invoices for $50 to both Landay and PC&G (collectively, "Appellees") for "professional services rendered." Appellees paid the invoices, and Rite Aid provided the requested copies of the pharmacy records. In 2010, Appellees filed a class action against Rite Aid. In Count I of the complaint, Appellees claimed that Rite Aid breached an implied agreement between the parties and Rite Aid that Rite Aid would provide copies of its records to its customers in a manner consistent with Pennsylvania law, limiting the amount that may be charged to the estimated actual and reasonable expenses incurred in connection with the reproduction of the requested records. Specifically, Appellees maintained that Rite Aid's act of charging a flat fee for the reproduction of records violated Section 6152(a)(2)(i) of the Medical Records Act (MRA). In Count II of their complaint, Appellees requested a declaratory judgment that the MRA prohibited Rite Aid from charging more than the reasonable expenses it incurred to reproduce the requested records, and, further, precluded Rite Aid from charging a flat fee. In this discretionary appeal, the issue this case presented for the Supreme Court's review was whether the MRA applied to the reproduction of records by pharmacies, and, if so, whether, and under what circumstances, pharmacies may charge customers a flat fee for the reproduction of records. The Court held that the Act did not apply to pharmacies, and, as a result, it did not address the flat fee issue. View "Landay v. Rite Aid" on Justia Law

Appellant, a six-year-old boy diagnosed with an autism-spectrum disorder, was receiving applied behavior analysis (“ABA”), a type of autism-related service, in his home. ABA was covered by his family’s insurance policy with Appellee Independence Blue Cross. Appellant’s family requested that Blue Cross cover similar ABA services to be provided at Appellant’s elementary school in 2009. The insurer denied the request, pointing to a place-of-service exclusion in the policy which specified that no services would be covered if the care was provided at certain types of locations, including schools. This decision was unsuccessfully appealed internally. The dispute was then submitted to an independent external review agency appointed by the Pennsylvania Department of Insurance. In December 2009, that agency upheld the denial based on the policy’s place-of-service exclusion. Meanwhile, the General Assembly passed Act 62 of 2008, which, inter alia, required that health insurance policies provide coverage for the treatment of autism spectrum disorders. In 2010, Appellant filed suit seeking declaratory and injunctive relief in the form of a ruling that the policy’s place-of-service exclusion is null and void under Act 62, as well as an order directing the insurer to cover Appellant’s medically necessary treatments. Blue Cross filed responsive pleadings and Appellant requested judgment on the pleadings. The court ultimately rejected the argument that the policy’s place-of-service exclusion was a general exclusion as contemplated by Section 764h(c). Thus, it held that, under Section 764h(a), Blue Cross was required to provide coverage for school-based ABA services during the relevant time period. The common pleas court ordered the insurer to “take action consistent with this decision.” On appeal, the Superior Court, sua sponte, questioned whether the common pleas court should have entertained the appeal under Act 62. The Pennsylvania Supreme Court allowed review to consider whether individuals diagnosed with autism spectrum disorders have the right to judicial review of a denial of insurance coverage, considering the language of Act 62. "Here, we are faced with a situation in which a litigant sought a declaration of his rights under a legislative enactment, a task over which the common pleas court could have exercised jurisdiction, pursuant to the Declaratory Judgments Act, in response to the correct form of pleading. Furthermore, the complaint’s asserted basis for jurisdiction was deficient only because of the confusion created by an apparent drafting mistake by our General Assembly. Neither the court nor the defendant Insurer realized that anything was amiss in this regard and, if they had, Appellant could presumably have made any necessary formal corrections. Under these circumstances, we conclude that the common pleas court was permitted to reach the substantive claim forwarded in Appellant’s pleadings. It follows that the intermediate court should not have reversed the order of that court by sua sponte pointing to the language of Section 764h(k)(2) as a bar to Appellant’s ability to seek relief in a judicial forum, without first evaluating whether the common pleas court’s assessment of the substantive question could be justified on some other basis." View "Burke v. Independence Blue Cross" on Justia Law

The issue this case presented to the Pennsylvania Supreme Court centered on the interpretation of Sections 6152(a)(1) and (a)(2)(i) of the Medical Records Act ("MRA,"42 Pa.C.S. secs. 6151-6160), which requires businesses such as appellee MRO Corporation, which reproduces medical records for patients and their representatives, to limit their copying charges to their estimated actual and reasonable expenses of reproducing requested charts or records (subject to a statutory ceiling rate), or whether such businesses may simply charge the statutory ceiling rate. Appellant asked the Court to review the Superior Court's finding that, where a medical records reproducer fails to disclose and charge its estimated actual and reasonable expenses and instead charges the MRA's ceiling rates which the records requestor then pays, the defenses of "voluntary payment" and "prior approval" bars the records requestor from maintaining a breach of contract claim to recoup alleged overpayments. MRO did not dispute that the MRA requires the records reproducer to disclose to the requestor “the estimated actual and reasonable expenses” of reproduction. But, MRO argues that the "expenses" so disclosed do not represent actual costs of reproduction; rather, MRO argues that "expenses" refers to the cost to the party making the request, and that expense is determined by the pricing schedule. In MRO's view, the pricing schedule establishes the "expense" to be estimated and then passed on to the requestor. "MRO's construction of the Act is intricate and ingenious in some respects, and it articulates what may be a rational and legitimate approach to the general question of how best and fairly to regulate the expenses of securing medical records." However, the Supreme Court did not believe that the structure and plain language of the provisions of the Act at issue here supported MRO's construction. The Supreme Court reversed the Superior Court and remanded the matter to the trial court for further proceedings. View "Wayne M. Chiurazzi Law, Inc., et al. v. MRO Corporation" on Justia Law

This case was among a number of civil actions brought by state attorneys general against pharmaceutical companies challenging the propriety of prescription drug pricing, as it impacted third-party reimbursement for brand-name drug purchases subsidized by government social welfare programs. The Commonwealth focused its claims upon alleged overpayments tied to the use of an industry benchmark figure (average wholesale price, or "AWP") in government reimbursement formulas. While many issues of concern were raised about the Commonwealth’s approach to this litigation and the judgment it has obtained, the Pennsylvania Supreme Court overturned the monetary component of that judgment grounded on the Commonwealth’s failure to offer a rational accounting for the billion dollars in rebate monies which Commonwealth agencies received from the drug manufacturers it sued. View "Pennsylvania v. TAP Pharmaceutical Products, Inc." on Justia Law

In a direct appeal, the issue before the Supreme Court in this case was the constitutionality of legislation mandating a one-time transfer of money from the Medical Care Availability and Reduction of Error Fund to Pennsylvania's General Fund. The Commonwealth faced a budget impasse for the 2009-10 fiscal year that lasted approximately 100 days. An interim budget was passed, and impasse was resolved when the Governor approved a supplemental appropriations bill, as well as implementing legislation making amendments to Pennsylvania's Fiscal Code. One of Act provisions designed to balance the budget directed that $100 million be transferred from the MCARE Fund to the General Fund. Appellees sought a declaration that: (1) the transfer of $100 million from the MCARE Fund to the General Fund extinguished vested rights or constituted an illegal taking in violation of the due process guarantees contained the Commonwealth and federal constitutions; and (2) the transfer violated the Uniformity Clause of the Pennsylvania Constitution. Concerned that the Commonwealth might effectuate the transfer and dissipate the funds, Appellees filed an application for preliminary injunctive relief (a temporary restraining order). After review, the Supreme Court concluded that the October 2009 amendment to the Fiscal Code transferring $100 million from the MCARE Fund to the General Fund implicated the providers' due process rights, but that the question of whether the legislation was finally unconstitutional requires further factual development. Accordingly, the Court reversed the Commonwealth Court's order granting summary relief. View "Geisinger Health System, et al v. Pennsylvania" on Justia Law

Appellants sought a new trial in this medical battery/lack-of-consent case on the ground that the trial court erroneously instructed the jury on the technical elements of battery, particularly the intent to cause a harmful or offensive contact. They further maintained that the charge was erroneous because it instructed the jury that Appellants-Plaintiffs were required to prove that the surgeon who performed the allegedly unauthorized operation did so with the intent to harm. Viewing the jury charge in its entirety, the Supreme Court concluded that it clearly and accurately set forth the law. Contrary to Appellants' contentions, the jury charge did not require proof that the surgeon performed the operation with the intent to harm. Accordingly, the Court affirmed the order of the Superior Court, which affirmed the trial court's entry of judgment on the verdict in favor of Appellees. View "Cooper v. Lankenau Hospital, et al" on Justia Law

The Department of Public Welfare (DPW) and the Office of the Budget of the Commonwealth of Pennsylvania appealed a Commonwealth Court order which granted summary judgment to Appellees the Pennsylvania Medical Society and its individual members, and the Hospital and Healthsystem Association of Pennsylvania and its individual members. The court declared that the Commonwealth had an obligation under the Health Care Provider Retention Law (the Abatement Law) to transfer monies to the Medical Care Availability and Reduction of Error Fund (MCARE Fund) in an amount necessary to fund dollar for dollar, all abatements of annual assessments granted to health care providers for the years 2003-2007. Upon review of the Commonwealth Court record, the Supreme Court held that the Abatement Law gave the Secretary of the Budget the discretion, but not the obligation, to transfer monies into the MCARE Fund in an amount up to the total amount of abatements granted. Furthermore, the Court concluded that Apellees had no statutory entitlement to the funds held in abatement, nor a vested right to them. View "Pa. Medical Society v. Pennsylvania" on Justia Law

Appellant Robert Petty is sole owner of Co-Appellant R.G. Petty Masonry. Appellants contracted with Respondent Blue Cross of Northeastern Pennsylvania (Blue Cross), a nonprofit hospital corporation that provides health insurance coverage for its employees. Appellants are covered under the group policy as subscribers. Appellants filed a four-count class action suit against Blue Cross, alleging that it violated the state Nonprofit Law by accumulating excessive profits and surplus well beyond the "incidental profit" permitted by statute. The second count alleged Blue Cross breached its contract with Appellants by violating the Nonprofit Law. The third count alleged Blue Cross owed appellants a fiduciary duty by virtue of their status as subscribers, and that duty was breached when it accrued the excess surplus. The fourth count requested an inspection of Blue Cross' business records. The trial court found Appellants lacked standing to challenge Blue Cross' alleged violations of the Nonprofit Law and dismissed the suit. The Commonwealth Court affirmed the trial court. Upon careful consideration of the briefs submitted by the parties in addition to the applicable legal authorities, the Supreme Court found that Appellants indeed lacked standing under the Nonprofit Law to challenge Blue Cross by their four-count complaint. Accordingly, the Court affirmed the lower courts' decisions and dismissed Appellants' case. View "Petty v. Hospital Service Assoc. of NE Penna." on Justia Law