According to data obtained from SmartTrak Medical Device and Wound Market Intelligence, in the third quarter of 2024 (Q324), the US Skin Substitute / Cellular Tissue Product (CTP) market reached $1.75 BILLION. That figure is up 64.0% compared to the third quarter of 2023 (Q323) – one year ago. Amniotic products held the vast majority of the US market at 79.1% share, up from 73.3% in Q323.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
The company you want to be looking into (which you mentioned before) is Extremity Care. They are probably the biggest distributor of these products and most of their clients are most likely abusing the Medicare loophole. Some are small time podiatrist offices and decent sized mobile wound care clinics. The ceo established a parent company called Tiger Biosciences LLC and in the last year, he’s used the funds he made off of these products to purchase several companies in the US, Germany and Poland. He is trying to move into beauty/aesthetic products along with medical equipment. My guesstimation is that with the upcoming CMS changes (none of their products are on the approved list), he’s trying to pivot into different industries to keep his money train/startup empire rolling. This company has made an obscene amount of money in just two years and nobody really knows about it since it is a privately held company. They also own the manufacturer of their CPT product called REGENTX based in Texas. When there are product issues, they buy the same products from different companies to distribute. The products Extremity Care distributes are essentially the same, but they rebrand them every quarter to make the most profit off of them. Their sales reps make millions a year along with their “Chief Legal Officer.” Source: Former employee prior to the company taking off.
Well stated. Legacy medical -Zenith. Bio, Royal biologics- amniomaxx 2 more of the culprits.
Jbh
This is a serious question, how is this Amniotic scheme a lot of these companies offer not a conspiracy to commit Medicare Fraud? The players seem to be the manufacturer, the distributor and/or independent sales representative, a billing company and the Physician. On the surface, the Physician assumes all of the risk with claw backs, when really, this is a coordinated effort with all the parties previously mentioned involved and financially benefiting greatly from the scheme. It is usually a sale representative that approaches the physician with the scheme.
The system includes applying these grafts with astronomical temporary coding and reimbursement to Medicare patients. These grafts cost a fraction of this price to produce and are usually sold at a fraction of the cost to hospitals and asc’s. Once the Physician gets paid the astronomical Medicare reimbursement for the in office application, the manufacturer will then discount the invoice to the physician, the physician then keeps the remainder of the difference and the manufacturer and sales representative then split up the still heavily inflated cost of the graft.
Example: Physician bills $90k for one graft application and gets reimbursed $90k on that -> Manufacturer provides 50% discount that the physician does not report to medicare -> physician keeps $45k then pays manufacturer the other $45k -> the manufacturer and sales representative split up that $45k. The billing company gets their usual percentage to process the claims.
With very simple math, this seems to be an issue that is costing Medicare billions. Multiply $100k to a $1million per patient by how many physicians are participating. That one practice alone in AZ was almost a billion dollars. From your other posts Dr. Fife, Medicare has taken notice and has audits on the books for 2025 and 2026. My other question is, will the Physicians be forced to point fingers at the manufacturers and representatives they are partnered with? It seems very easy to follow the money on this. What did the physician bill and get reimbursed from Medicare vs what was the final payment the physician made for the graft.
The specific company I worked for it cost them roughly $8.00 USD to manufacture their main cpt product. They also engaged in all of the shady examples that you’ve mentioned.