The cost of care—everyone’s talking about it. But when it comes to wound care fraud and abuse, even federal watchdogs are sounding the alarm. According to the Health and Human Services Office of Inspector General, Medicare Part B expenditures for skin substitutes skyrocketed to over $10 billion annually by the end of 2024.
Even more concerning? Their use in nursing facilities jumped from 7% in early 2023 to 12.5% by late 2024. As the OIG stated in their recent alert, “Action is urgently needed to rein in the massive increases in Medicare Part B spending for skin substitutes.” You can read their full report on Medicare Part B payment trends and fraud concerns here.
In response, the Centers for Medicare & Medicaid Services (CMS) has proposed changes to the way skin substitutes are classified and reimbursed. The plan? Align them with their FDA regulatory status and pay based on clinically relevant characteristics. As outlined in the CY 2026 OPPS and ASC Proposed Rule, this approach could promote innovation and save money. But it’s not without controversy.
Wound care stakeholders are raising red flags. In a recent article in the Journal of Wound Care, advocates warned that these payment reforms might unintentionally undermine access to cellular, acellular, and matrix-like products (CAMPS). These are critical for patients with hard-to-heal wounds—especially older adults, those with disabilities, and medically underserved populations.
Martha Kelso, CEO of Wound Care Plus and a board member of the Post Acute Wound & Skin Integrity Council (PAWSIC), made it plain in a statement featured by McKnight’s Long-Term Care News: “These products are vital to treating hard-to-heal wounds… the current proposal threatens access to life-saving therapies.” The concern is that while CMS tries to control waste and improve payment consistency, it may do so at the expense of resident outcomes and the very infrastructure that supports wound care innovation.
So where do we go from here? Let’s start at the beginning. Prevent the wound before it starts. Review your skin integrity program—don’t just pull it out, dust it off, and hope for the best. Times have changed, and treatment protocols have evolved. But one thing remains constant: frail elders still need reliable prevention interventions, and they need every caregiver to follow them.
The conversation about wound care fraud and abuse isn’t just about dollars—it’s about dignity, outcomes, and the systems we rely on to care for our most vulnerable residents.
Stay well and stay informed!
