Why Wound Care Denials Are Rising
Medicare contractors are increasingly denying skin substitute and wound care claims by labeling them “experimental or investigational” often relying on sub regulatory guidance rather than the actual Medicare statute. At the same time, HHS-OIG has flagged explosive growth in Part B spending on these products, and DOJ has opened False Claims Act cases and criminal investigations tied to wound care billing.
This white paper gives providers, manufacturers, and counsel a strategy for:
- Challenging the “experimental” label — where it actually comes from, and why it isn’t automatically the law
- Protecting cash flow during recoupment — timely appeals, extended repayment options, and when injunctive relief is realistic
- Building a record for federal court — what it takes to preserve a challenge all the way through Council review
- Separating a coverage dispute from a fraud allegation — so a debatable Medicare denial doesn’t get treated as evidence of fraud