Patient Stories
As The New York Times reported in April 2025, a wound-care doctor applied nine skin substitutes over just three months, billing Medicare $324,000 for her care. The procedures offered little benefit and came with serious risk. Only days after the final graft, Patricia developed a severe infection. Within a week, she died of sepsis.
Her daughter, Michelle Livingston, later shared her story with The Times as part of an investigation into Medicare’s ballooning spending on these products, spending that topped $10 billion in 2024, often with scant physician oversight or evidence of benefit.
Patricia’s story illustrates what happens when financial incentives outweigh patient safety. She represents thousands of seniors whose lives have been disrupted or ended by a system that rewards volume, not value.
Source: “Medicare Bleeds Billions on Pricey Bandages, and Doctors Get a Cut,” The New York Times, April 10, 2025.
Without a primary care doctor overseeing his treatment, Barry’s chronic wounds were handed off to independent wound-care specialists. Over just three months, they performed 12 surgical procedures and applied 12 expensive skin substitutes – racking up more than $3.5 million in Medicare claims. None of the usual safeguards were followed: no step therapy, no infection control, no oversight from a physician.
The results were devastating. Barry’s wounds became so neglected that maggots were later found in the tissue. He was hospitalized twice for severe sepsis and, after weeks of decline, lost his leg below the knee.
Doctors had never used skin substitutes when Barry was under Medicare Advantage, which usually doesn’t reimburse for them. But once he entered traditional Medicare – where payments are generous – the aggressive treatments began immediately.
Eventually, Barry was aligned to an accountable care organization, which identified the unusual spending and stepped in to manage his recovery. Today, Barry lives in a nursing home, his independence gone, the cost to taxpayers enormous, and the cause undeniable: Profit-driven misuse of wound-care products.
This patient’s name has been changed to protect their privacy. Details are drawn from real Medicare claims and verified care documentation.
Over just a few months, Maria received 12 skin-substitute applications from multiple providers – generating more than $10 million in Medicare claims. Every procedure was billed as a home service, totaling over 7,000 square centimeters of skin substitutes.
Maria hadn’t seen her primary care doctor since spring 2023. During this period, she received no lab work, follow-up visits, or rehabilitation – only repetitive wound-care procedures. She eventually transitioned to hospice and died in July.
The scale, cost, and frequency of these procedures fell far outside accepted standards of care. Despite aggressive interventions, there was no evidence her wounds ever improved.
But the human toll was worse than the $10 million spent. Maria’s health declined rapidly, and she died alone; the victim of a treatment pattern driven by profit, not medical necessity. Her story shows what happens when oversight fails and when Medicare becomes a marketplace for exploitation instead of healing.
This patient’s name has been changed to protect their privacy. Details are drawn from real Medicare claims and verified care documentation.
Over the span of just two months, Eleanor received more than $7.5 million in wound-care treatments, mostly high-cost skin substitutes applied repeatedly near the end of her life. Her care team only submitted claims for these services long after she had passed away. In fact, Medicare didn’t begin paying the claims until May, months after her February and March procedures.
The ACO learned about the situation only when the bills were processed. By then, it was too late. Eleanor had died, and the ACO was left on the hook for millions of dollars in costs it couldn’t control.
Eleanor’s story is a heartbreaking example of how the system fails when oversight breaks down. Aggressive billing, delayed reporting, and a total lack of coordination left her vulnerable and turned her final months into a financial and clinical tragedy.
This patient’s name has been changed to protect their privacy. Details are drawn from real Medicare claims and verified care documentation.
In 2024, federal prosecutors uncovered one of the largest health-care fraud schemes in U.S. history – a $1 billion Medicare scam run by a Scottsdale couple who marketed unnecessary wound grafts to frail seniors and hospice patients.
The company they founded, APEX Medical, recruited untrained salespeople and paid nurse practitioners up to “1,000 each time they applied “skin substitutes” even when patients were near death or received no medical benefit. Many were in hospice care, subjected to painful and costly procedures their doctors never ordered.
Over just two years, the scheme billed Medicare more than $549 million, profiting from dying patients while draining taxpayer funds. Agents later seized $50 million in bank accounts, gold bars, and jewelry.
In October 2025, Alexandra “Lexie” Gehrke was sentenced to 15 ½ years in federal prison and ordered to repay more than $600 million in restitution. A judge called her crimes “unmitigated greed.”
For the patients caught in her web, the toll can’t be measured in dollars. Many spent their final days enduring needless, painful wound procedures, a stark reminder of how Medicare’s payment loopholes can turn human suffering into profit.
In the spring of 2025, Robert, became the target of an egregious case of skin substitute abuse.
Over just six weeks, an outside wound-care provider – one who had never been referred by his ACO or any of Robert’s doctors – visited his home repeatedly and billed $9 million in skin substitutes. Robert had no idea what these products cost. He was never informed of their price, never charged any coinsurance, and assumed the treatments were legitimate.
When the ACO noticed the first claims in May, staff immediately reached out to Robert to explain what was happening. Shocked by the staggering cost, he agreed to stop treatment right away. But by then, it was too late – Medicare had already spent millions of dollars on medically unnecessary services.
Robert’s story highlights how easily fraudulent providers can exploit loopholes in Medicare’s payment system. Without stronger safeguards, these abuses will continue, wasting taxpayer dollars and putting patients at risk.
This patient’s name has been changed to protect their privacy. Details are drawn from real Medicare claims and verified care documentation.
Elaine was a hospice patient receiving comfort-focused care for a chronic wound under the supervision of her hospice nurse. Despite clear signs of poor circulation that made healing unlikely, an outside wound care provider began treating Elaine with expensive skin substitutes – without consulting the hospice team or reviewing her medical records.
The treatments were painful and inappropriate. The provider performed aggressive wound cleanings and continued applying the products even after hospice staff requested that the treatments stop. Elaine’s wound worsened, becoming infected and larger over time. She required increased doses of pain medication to tolerate the procedures and ultimately was transferred to a general inpatient unit as her condition declined. She died soon after from complications tied to the unnecessary skin substitute treatment.
This tragic case, reported by an affiliated hospice agency, shows how lack of coordination and oversight enables harm to the most vulnerable patients. In Elaine’s final weeks, she needed compassion and comfort – not invasive, profit-driven procedures that caused pain and hastened her decline.
This patient’s name has been changed to protect their privacy. Details are drawn from real Medicare claims and verified care documentation.
The Problem
Medicare spending on skin substitutes – products made from biological or synthetic materials for hard-to-treat wounds – has increased more than 50-fold in just over six years, expected to top $13 billion in 2025.
While these products can be clinically valuable in narrow circumstances, a broken payment system has fueled profiteering, patient harm, and runaway costs. Some new skin substitutes cost as much as $5,800 per square centimeter, and unscrupulous wound care clinics have billed hundreds of thousands – or even millions – of dollars per patient, often for people in hospice or with minor wounds.
The Health and Human Services’ Inspector General recently confirmed what clinicians and accountable care organizations have been reporting: widespread misuse, limited oversight, and “questionable billing” practices that endanger patients and drain Medicare’s resources.
Every dollar wasted on ineffective, exploitative care is a dollar diverted from seniors who truly need it – and from strengthening Medicare’s long-term solvency.
Why It Matters
This is more than a fiscal issue – it’s a patient safety crisis.
Every dollar wasted on ineffective, exploitative care is a dollar diverted from seniors who truly need it – and from strengthening Medicare’s long-term solvency.
The Role of Accountable Care
ACOs are on the front lines of identifying and preventing fraud, waste, and abuse. Because ACOs are responsible for patients’ total cost of care, they have a unique incentive to detect unusual spending patterns and act quickly to protect patients.
Across the country, ACOs have:
This is the promise of accountable care in action—using data, coordination, and oversight to protect both patients and taxpayers.
CMS Finalizes Payment Policy
Accountable for Health applauds CMS for taking decisive action to end the skin substitutes crisis. On Friday, October 31, 2025, the agency released the Physician Fee Schedule Final Rule:
Requiring skin substitutes to be billed alongside other physician services
Setting a single rational payment rate of $127 per square centimeter, cutting spending by 90%.
Accountable for Health is deeply appreciative of this policy. Read the Press Release.
Our Call to Action
Additional steps are needed to protect ACOs and their patients:
These policies will ensure that honest clinicians aren’t punished for others’ abuse – and that Medicare remains sustainable and accountable.
Skin Substitute Resources
These resources highlight the urgency of reform and the leadership of ACOs in safeguarding patient care and Medicare integrity: