{"id":18583,"date":"2025-04-10T16:13:47","date_gmt":"2025-04-10T16:13:47","guid":{"rendered":"https:\/\/site.itshrt.com\/worldnews\/medicare-bleeds-billions-on-pricey-bandages-and-doctors-get-a-cut\/"},"modified":"2025-04-10T16:13:47","modified_gmt":"2025-04-10T16:13:47","slug":"medicare-bleeds-billions-on-pricey-bandages-and-doctors-get-a-cut","status":"publish","type":"post","link":"https:\/\/site.itshrt.com\/worldnews\/medicare-bleeds-billions-on-pricey-bandages-and-doctors-get-a-cut\/","title":{"rendered":"Medicare Bleeds Billions on Pricey Bandages, and Doctors Get a Cut"},"content":{"rendered":"<p> <script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-6606220950177433\"\r\n     crossorigin=\"anonymous\"><\/script>\r\n<!-- ItShrt World News -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-6606220950177433\"\r\n     data-ad-slot=\"1882483372\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\r\n<br \/>\n<\/p>\n<div>\n<p class=\"css-at9mc1 evys1bk0\">Companies can set such high prices because of a quirk in Medicare pricing rules, industry experts said. For the first six months of a new bandage product\u2019s life, Medicare will set the reimbursement rate at whatever price a company chooses. After that, the agency adjusts the reimbursement to reflect the actual price paid by doctors after any discounts.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">To circumvent the reimbursement drop, some companies simply roll out new products.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">In April 2023, Medicare began reimbursing $6,497 for every square inch of a bandage called Zenith, sold by Legacy Medical Consultants, a company in Fort Worth, Texas. Six months later, Zenith\u2019s reimbursement fell to $2,746.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">That month, October 2023, Medicare began reimbursing $6,490 for a new Legacy product, called Impax.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Marketing materials for the two products use identical photographs and language, aside from the brand names. The company describes both products as providing \u201coptimal wound covering and protection during the treatment of wounds.\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Since 2022, spending on Zenith and Impax has exceeded $2.6 billion, according to Early Read\u2019s analysis.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Legacy Medical Consultants did not answer questions about the marketing and pricing of those products. \u201cLegacy is following the law, not taking advantage of the system,\u201d Dan Childs, a company spokesman, said in a statement.<\/p>\n<h2 class=\"css-13o6u42 eoo0vm40\" id=\"link-7070c51\">Doctor Discounts<\/h2>\n<p class=\"css-at9mc1 evys1bk0\">A cottage industry of doctors and nurses make house calls to treat wounds. Some skin substitute companies pitch themselves to wound care doctors by offering a cut of the rising bandage prices.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Dr. Caroline Fife, a wound care doctor from Texas who often writes about industry excesses, shared on her blog last year an <a class=\"css-yywogo\" href=\"https:\/\/carolinefifemd.com\/2024\/03\/27\/an-offer-you-cant-refuse-a-4x4-would-generate-a-little-over-20000-for-your-practice\/\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">email<\/a> she received from an undisclosed skin substitute company. The company boasted that other doctors had developed \u201ca healthy revenue stream\u201d from its bandages and that a patch smaller than a credit card \u201cwould generate a little over $20,000 for your practice.\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Some companies offer doctors a \u201cbulk discount\u201d of up to 45 percent, according to doctor interviews and contracts reviewed by The Times. But doctors then collect a Medicare reimbursement for the full price of the product.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Anti-kickback <a class=\"css-yywogo\" href=\"https:\/\/oig.hhs.gov\/compliance\/physician-education\/fraud-abuse-laws\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">laws<\/a> prohibit doctors from receiving financial rewards from drug companies or medical suppliers. And although Medicare does allow bulk discounts, experts said that the bandage rebates could have violated federal law because they didn\u2019t actually require high-volume purchases. In some Legacy contracts reviewed by The Times, doctors had to buy only three products to qualify for a 40 or 45 percent discount.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">\u201cThat is not a volume discount,\u201d said Reuben Guttman, a lawyer in Washington, D.C., who has represented many Medicare whistle-blowers. Mr. Guttman said that such labeling could be used to conceal a kickback.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">In 2024, at least nine medical practices billed Medicare more than $50 million for skin substitutes, according to an analysis done for The Times by the National Association of Accountable Care Organizations, which represents medical groups that are incentivized to curb Medicare spending.<\/p>\n<\/div>\n<p><script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-6606220950177433\"\r\n     crossorigin=\"anonymous\"><\/script>\r\n<!-- ItShrt World News -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-6606220950177433\"\r\n     data-ad-slot=\"1882483372\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\r\n<br \/>\n<br \/><a href=\"https:\/\/www.nytimes.com\/2025\/04\/10\/health\/skin-substitutes-medicare-costs.html\">Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Companies can set such high prices because of a quirk in Medicare pricing rules, industry experts said. For the first<\/p>\n","protected":false},"author":1,"featured_media":18584,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[36],"tags":[929,1412,135,2717,138,140,134,219,1851,111],"class_list":["post-18583","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-2","tag-diabetes","tag-elderly","tag-fees-and-rates","tag-frauds-and-swindling","tag-health-insurance-and-managed-care","tag-medicare","tag-prices-fares","tag-regulation-and-deregulation-of-industry","tag-skin","tag-united-states-politics-and-government"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Medicare Bleeds Billions on Pricey Bandages, and Doctors Get a Cut - World News<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/site.itshrt.com\/worldnews\/medicare-bleeds-billions-on-pricey-bandages-and-doctors-get-a-cut\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Medicare Bleeds Billions on Pricey Bandages, and Doctors Get a Cut - World News\" \/>\n<meta property=\"og:description\" content=\"Companies can set such high prices because of a quirk in Medicare pricing rules, industry experts said. 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