by Caroline Fife, M.D. | Jul 19, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitute Arrests, CTP / Skin Substitutes
District of Arizona | Seven Charged in Arizona as Part of the Department of Justice’s 2024 National Health Care Fraud Enforcement Action | United States Department of Justice The fallout continues from the indictments of Alexandra Gehrke and Jeffrey King on charges of...
by Caroline Fife, M.D. | Jul 17, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Dr. Marissa Carter
Dr. Marissa Carter and I have published, “Counting the Cost of Cellular and/or Tissue-Based Products in Diabetic Foot Ulcers: Is There a Justifiable Price Limit per Square Centimeter?” now available in Advances in Wound Care. Recently I asked readers to predict what...
by Caroline Fife, M.D. | Jul 12, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
Thank you for participating in the poll to guess how ridiculously high amniotic prices will go. It looks like $5000 per cm may be the winner of this perverse method of helping to bankrupt Medicare and line the pockets of unscrupulous practitioners! I will keep you...
by Caroline Fife, M.D. | Jul 11, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
The Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2025 Medicare physician fee schedule (PFS). The big question in our field was whether CMS would start “package pricing” CTPs/skin subs in the physician office. They didn’t –...
by Caroline Fife, M.D. | Jul 10, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
The Outpatient Prospective Payment System (OPPS) proposed rule has come out! It will take time to read and digest so details will follow. At first glance, there are no changes to Cellular Tissue Product /skin substitute payment, which remain under package pricing in...
by Caroline Fife, M.D. | Jul 9, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
I am trying to understand the mechanics of the way that practitioners make money off the CTP/skin sub itself. In principle it sounds straightforward, but in reality, “it’s complicated.” A clinician sent me these 2 invoices for the same amniotic product applied in the...
by Caroline Fife, M.D. | Jul 8, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
Sadly, it appears that the CTP/skin sub industry has become a game, the goal of which is to fleece Medicare. You can argue that this is not so (and I’d love to get a respectfully worded message or email from you with your thoughts!), but it looks that way to me–...
by Caroline Fife, M.D. | Jul 5, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight
Politico released an article about the billion dollar scam of “skin substitutes.” It’s behind a pay wall, so I will summarize the key points. (I will use the term “skin substitutes” since that’s how they are referred to in the Politico article.) Since I started...
by Caroline Fife, M.D. | Jul 1, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
I have posted blogs about the fact that the pricing of skin subs is continuously escalating. There are amniotic products out there now which are more than $3,000 cm2, and there is ZERO data to suggest that they are any better than amniotic products 100 times cheaper....
by Caroline Fife, M.D. | Jun 28, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitute Arrests, CTP / Skin Substitutes
Yesterday (June 27th) the Department of Justice (DOJ) announced that the two wound care company owners have been accused of accepting more than $330 million in kickbacks as part of a scheme to fraudulently bill Medicare for amniotic grafts. The report states that more...
