The New York Times recently published a high-profile investigative article titled “Medicare Bleeds Billions on Pricey Bandages, and Doctors Get a Cut.” The story takes aim at Medicare’s growing expenditures on skin substitute grafts, particularly those derived from placental tissue, and raises sharp questions about provider profits, overutilization, and marketing practices by suppliers.
For providers using these skin graft products, the message is clear: The audit spotlight just got brighter.
While the article has drawn criticism from industry insiders, including a strongly worded response piece from the Massachusetts Wound Care Coalition, which condemned the NYT’s piece as an “inaccurate and dangerous portrayal of life-saving skin substitutes,” the damage in terms of regulatory scrutiny and payer reaction is already done.
The Risk of Increased Media Scrutiny
Media coverage like this adds fuel to the fire for Medicare and commercial payors already engaged in aggressive cost containment. This kind of reporting often leads to:
- Targeted audits
- Payment suspensions
- Post-payment reviews
- False Claims Act Civil and Criminal investigations
Payors are now even more incentivized to pursue recoupments where documentation fails to meet evolving medical necessity standards, especially in cases involving high-cost skin substitute grafts.
How To Protect Your Practice
High-profile articles scrutinizing Medicare spending and the physicians who provide those services tend to yield a response from regulators and payors alike. If you have not made coding, billing, and documentation of your skin grafting practices a priority before, now is the time to:
- Review current documentation practices to ensure they support wound staging, graft selection, size, and frequency.
- Reassess supplier agreements for any rebates, volume-based pricing, or consignment models that could raise compliance flags.
- Prepare proactively for audits, especially those targeting the use of biologics and high-reimbursement DME.
How Frier Levitt Can Help
Frier Levitt has extensive experience supporting providers through payor audits, overpayment demands, and compliance reviews, with significant experience involving skin substitutes and biologic grafts. Our firm can help ensure your practice is compliant from a regulatory, billing and documentation standpoint. If audited, our team has handled dozens of wound care audits and regularly appears before Administrative Law Judges in defense of providers nationwide.
If your practice is concerned about exposure or has received audit letters, demand requests, or pre-payment reviews related to skin substitute billing, contact Frier Levitt for assistance.
