Wound Care
Skin substitute reimbursement, debridement upcoding, and Medicare prepayment review for wound care providers.
Medicare Payment Suspensions for Wound Care Providers
A credible allegation of fraud can suspend a wound care practice's Medicare payments under 42 CFR 405.371 before any appeal, with…
Civil Investigative Demands in Wound Care Cases
A wound care CID tests medical necessity and kickback exposure together. What a provider produces, and how, shapes whether DOJ int…
Wound Care Billing Data That Triggers Federal Investigations
Graft size, application frequency and site of service are three billing variables OIG's own data snapshot says analytics flag in s…
Skin Substitute Fraud Indictments and How the Cases Are Built
DOJ's 2026 wound care takedown shows how prosecutors use claims data, distributor payments, and patient files to build skin substi…
Grand Jury Subpoenas to Wound Care Practices
A grand jury subpoena to a wound care practice triggers an immediate preservation duty and real obstruction risk, distinct from a…
Wound Care Provider Compensation Arrangements: Product Use and Productivity Incentives
Wound care bonuses tied to product use or referral volume can trigger Anti-Kickback Statute and Stark Law exposure, not ordinary p…
Responding to an OIG Subpoena in a Wound Care Investigation
What an OIG subpoena requires, why skin substitute billing is under federal review, and how wound care practices preserve document…
Wound Care Modifiers Under Audit: 25, 59, JW and JZ
Medicare reviewers test modifiers 25, 59, JW and JZ on wound visits, debridement and skin substitute claims against the record, no…
Wound Care Claims Under Targeted Probe and Educate Review
Wound care claims fail Targeted Probe and Educate review over debridement coding errors and skin substitute documentation gaps, no…