Check out the entire series here.
I know this story qualifies as hearsay. I could provide the names of the companies involved, but I can’t afford the legal bills. Since I can’t provide the details, you don’t know whether to believe me, but here goes:
- A doctor called me who does case reviews for private insurance companies who provide Medicare secondary policies. He’s been getting asked to review claims for the in-home application of CTPs/Skin subs.
- To set the stage, all these patients have Medicare as the primary, but their Medicare benefits have run out, and now the bills have been submitted to the secondary (private payer).
- I won’t tell you what companies are providing the secondary insurance in these cases, but they are big ones.
- The doctor described one of several cases he has been asked to review — not revealing patient names or dates. One case he described was a patient with a “superficial pressure ulcer” on the buttock.
- A Physician’s Assistant came to the home and performed a superficial debridement and cleansing and applied a CTP/Skin sub (I am not going to say the product name) at the cost of $18,000 for one piece. The ulcer was 2.5 cm x 3 cm.
- The CTP was applied 10 times on 10 separate visits by this PA, and the total bill to the private payer was $180,000.
- No information was available to the case reviewer as to whether the patient was on an off-loading mattress or had any type of nutritional evaluation.
- The company that sent the Physician’s Assistant to do the applications provides these services, focused on “wound care”, in several different states.
- This is only one case of many that the doctor has been asked to review for medical necessity.
- The doctor who called me said he had another case with a bill in excess of $500,000. None of the claims were for less than $100,000.
Let me recap what I now understand. There are companies that exist (perhaps solely) to provide the in-home application of specific CTPs/skin subs at the cost of thousands of dollars each. The charges can add up to six figures for each patient. The CTPs/skin subs are not always applied by a physician. This is happening in many different states to many patients.
I have officially run out of words.