Get that Skin Substitute “Clawback Insurance!”

I’ve discussed the fact that nearly everyone is being audited by Medicare on their charges for Cellular Tissue Products (CTP’s) / Skin Substitutes. Depending on the type of audit, a practitioner can have to pay back not only the money they received for the specific patient visits under the audit (assuming the practitioner loses all their appeals) but they might have to pay back a percentage of all claims for CTPs going back several years. Yes, practitioners can make a LOT of money on an amniotic that is $3,450 per cm2 (those prices just keep going up!) thanks to under the table discounts. However, if they lose an audit, they will have to pay CMS back all the money they received. In fact, some practitioners have whispered to me that they have written checks for many millions of dollars after a Medicare audit. (If anyone is willing to tell their story even anonymously, I will publish it, because people think I am exaggerating.)   

The total amount recuperated by CMS could mean financial ruin for a practitioner. However, there’s an answer! To help practitioners out, amniotic companies are offering “clawback insurance.” This email was forwarded to me by a colleague. (It is important to note that clawback insurance is a real thing and might be a good idea to have.) However, it should tell you something about the ubiquitous nature of Medicare audits for skin subs – and their success rate – that some amniotic companies are offering insurance policies to defray practitioner losses from Medicare audits.  That sounds like an admission that Medicare paybacks are a problem.

There is one thing these companies don’t offer to help with – and that’s the cost of criminal defense. Most of you guessed this correctly in a recent poll! High-priced amniotic distributors are offering financial incentives for application volume (which sound like kickbacks to me, but I am not a lawyer) and they are providing clawback insurance. They do NOT pay for a criminal defense attorney. Yes, you can get insurance for the payment of civil penalties. You cannot get insurance for crimes. What worries me the most about this whole boondoggle is that that the Department of Justice (DOJ) may get to decide whether a discount on a skin sub was actually a kickback.  It’s possible that practitioners who “only” have to pay back money will be the lucky ones.