by Caroline Fife, M.D. | Jul 9, 2025 | Fight the Good Fight, Healthcare Payment Policy
CMS has released Quality Payment Program (QPP) performance data for 2023. Under the QPP, payment “adjustments” (bonuses and penalties) occur two years after the “performance year,” so that 2023 scores impact a practitioner’s 2025 Medicare payments. It’s important to...
by Caroline Fife, M.D. | Jul 7, 2025 | Medicare Audits
CMS says scammers are sending Medicare providers and suppliers phishing fax requests for medical records and documentation, falsely claiming to be part of a Medicare audit. This notice was posted on the CMS website: “CMS has identified a fraud scheme targeting...
by Caroline Fife, M.D. | Jul 4, 2025 | Miscellaneous Musings
My grandmother was born in 1895 (or maybe 1896). Her grandfather was a Union solider in the Civil War and his grandfather was a Revolutionary War soldier. Hanging on the wall of her small house in the mountains of North Carolina was a copy of the famous engraving,...
by Caroline Fife, M.D. | Jul 1, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitute Arrests, CTP / Skin Substitutes
In yesterday’s press release, the specific mention of the abuse of “skin grafts” (sic) is from minutes 4:50 to 5:31 Excerpt from remarks by Matthew Galeotti, Head of the Department of Justice (DOJ) Criminal Division, June 30, 2025: “Many of the defendants charged as...
by Caroline Fife, M.D. | Jun 30, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitute Arrests, CTP / Skin Substitutes
Today the Department of Justice (DOJ) held a press conference which was led by Dr. Mehmet Oz, the Administrator of the Centers for Medicare and Medicaid (CMS) and officials from the DOJ, announcing the results of its 2025 National Health Care Fraud Takedown. The...
by Caroline Fife, M.D. | Jun 27, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitute Arrests, CTP / Skin Substitutes
The Houston Chronicle has reported that a Houston podiatrist and his business partner have been charged with $45 million in healthcare fraud in relation to the billing of bioengineered skin substitutes Dr. David Jenson and Nestor Refael Romero Magallanes are...
by Caroline Fife, M.D. | Jun 25, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
An article by SmartTRAK shows that Cellular Tissue Products (CTPs) / Skin Substitutes in the Physician Office and Mobile environment grew by over $5 Billion between 2021 and 2024 compared to only $1 Billion in all other care settings combined. The U.S. CTP/skin...
by Caroline Fife, M.D. | Jun 23, 2025 | Fight the Good Fight, Pressure Cooker: Rethinking Pressure Ulcers
Dear Dr. Fife, I am writing this letter as a general surgeon who is deeply concerned about our healthcare system. As you have pointed out in your blog, physician payments by CMS and private insurers are a fraction of what they were 20 years ago because physician...
by Caroline Fife, M.D. | Jun 20, 2025 | Fight the Good Fight, Pressure Cooker: Rethinking Pressure Ulcers
The National Quality Forum (NQF) has issued a request for public comment about their update on Serious Reportable Events (SREs). Every hospital-based outpatient wound center (HOPD) and “mobile” wound care practitioner needs to read this carefully. I hope all of you...
by Caroline Fife, M.D. | Jun 16, 2025 | Fight the Good Fight
I hear the most interesting things about when Medicare rules apply and about the requirements of the Merit-Based Incentive Payment System (MIPS). For example, two years ago, a doctor whose practice involved the application of CTPs/skin substitutes on patients in the...
