When A Resolved Billing Scandal Becomes Embedded In New Payment Policy Thomas Kornfield Daniel K. Shenfeld Ezekiel J. Emanuel April 1, 2026

https://www.healthaffairs.org/content/forefront/resolved-billing-scandal-becomes-embedded-new-payment-policy Between 2019 and 2024, fee-for-service (FFS) Medicare spending on skin substitutes—wound coverings used to treat chronic ulcers and similar skin conditions—rose nearly 40-fold, from roughly $256 million to more than $10 billion. This spike wasn’t driven by a sudden epidemic of skin ulcers. Perverse payment rules allowed providers to bill at an extraordinary scale: An investigation by the New York Times found cases of $14 million charged for a single patient’s bandages in one year, $6 million for coverings that failed to heal a wound, and $1.3 million for a patient who did not have a wound. The Centers for Medicare & Medicaid Services (CMS) eventually acted, overhauling skin substitute payment rules for 2026 and projecting nearly $20 billion in savings as a result.