by Caroline Fife, M.D. | Jul 14, 2025 | Pressure Cooker: Rethinking Pressure Ulcers
In the August 28, 2024 Final Rule (CMS‑3401‑F), CMS (the Centers for Medicare and Medicaid) updated the list of “Hospital Harms” in the Hospital Inpatient Quality Reporting (IQR) requirements. The new rule became effective this year. I will skip the...
by Caroline Fife, M.D. | Jul 11, 2025 | Hyperbaric Oxygen Therapy
(Photo: HavasuNews.com) Just before 11 am yesterday morning (July 10th, 2025), emergency crews responded to a 911 call about a fatal hyperbaric chamber fire at a facility in Havasu City, AZ. There is very little information available at this time, other than the fact...
by Caroline Fife, M.D. | Jul 11, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
Summary of the WISeR (Wasteful and Inappropriate Service Reduction) Model for Medicare (The summary below is partially excerpted from a more detailed review by Julie Rhodovi) Federal Register CMS Page and CMMI Page Model Original Medicare’s fee-for-service payment...
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...
