Subcontracted dental care rates not public

Dental Benefit Providers, Inc. v. Eiseman
Commonwealth Court of Pennsylvania
Nos. 945 C.D.2013, 957 C.D.2013, 958 C.D.2013

February 19, 2014

The Commonwealth Court ruled that records of rates paid by managed care organization subcontractors to dental service providers were not records of the Department of Public Welfare nor were they available to the DPW through third-party contracts. As a result, the records were not subject to disclosure under the Right to Know Law.


James Eiseman, of the Public Interest Law Center of Philadelphia, submitted a Right to Know Law request to the Department of Public Welfare (“DPW”) seeking records related to the rates managed care organization (“MCOs”) subcontractors paid to dental service providers.

The DPW was two contractual links away from these records. The DPW was contracted with the MCOs, the MCOs were contracted with the MCO subcontractors, and the MCO subcontractors were contracted with dental service providers.

The DPW, on the advice of the these third parties, denied Eiseman’s request under the Trade Secrets Act, the confidential proprietary information and trade secrets exemption of the RTKL, and a Department of Health Regulation.

Eiseman appealed to the Office of Open Records.

Basing its decision on written submissions, the OOR issued a Final Determination compelling the disclosure of the requested records.

The DPW, MCO subcontractors, and dental service providers appealed the Final Determination to the Commonwealth Court.

Commonwealth Court Decision

To determine if the records requested were within the possession of the DPW, the Commonwealth Court considered two different provisions of the RTKL.

The court first considered whether the rate contracts were records under the RTKL.

The court could not find any actual possession by the DPW, as it did not have a contract with the MCO subcontractors or the dental service providers.

However, the court continued the analysis to determine whether the DPW had constructive possession. Though the court determined that the standard contract between the DPW and MCOs has a provision that requires DPW approval of subcontracts, the standard contract contains a provision expressly exempting provider contracts from that approval process.

As a result, the court concluded that DPW does not have access to the records through contract.

Further, the court reasoned that though the records may be available to DPW on request, constructive possession is not established under the RTKL.

The court then analyzed whether DPW had possession of the records under the RTKL provision that grants access to records of third parties.

The provision requires that for these records to be available to the DPW, the third party perform a government function on behalf of an agency, and the information sought must directly relate to that function.

The court conceded that there was no doubt all the parties in this scenario performed a government function. However, for the records to be subject to disclosure under the RTKL, they must be in the possession of a third party with which the government has contracted.

Here, the court noted that the only parties to a government contract were DPW and the MCOs. As such, the records of rates between MCO subcontractors and dental service providers were outside the reach of the RTKL.

As a result, the Commonwealth Court reversed the OOR’s Final Determination.