When you work in the healthcare sector, especially in wound care, your focus should be on helping patients heal and improve their quality of life. However, not all practitioners prioritize their patients in the same way. Have you ever noticed something odd about the way skin grafts are handled in your workplace? One alarming practice is skin graft harvesting, where single-use skin substitutes are split and reused on multiple patients, all while billing each as though they received a full graft.
Podiatry wound care fraud like this not only harms patients, but also undermines the integrity of the healthcare system and violates federal laws. If you’ve noticed suspicious practices at your job, understanding how this fraud works and knowing the steps to report it can make a significant difference not just for your patients, but for healthcare overall.
How Podiatry Wound Care Works and the Fraud Behind It
A Brief Overview of Podiatry Wound Care
Chronic wounds, such as diabetic ulcers or injuries that fail to heal properly, pose serious risks to patients, including infection and even amputation. To treat these wounds, many podiatrists use skin substitutes (often known as skin grafts) to promote healing. These skin grafts are expensive and, by design, meant for single use only on one patient.
Here’s how the process is supposed to work. Physicians evaluate each patient’s wound, create a treatment plan, use the necessary amount of the skin graft, and then dispose of the remainder as required. Each graft is individually billed to Medicare or private insurers. This process ensures that every patient gets the appropriate care as prescribed.
Unfortunately, not every healthcare provider follows these ethical and legal standards.
How Fraud Takes Place
Skin graft harvesting occurs when providers improperly use leftover portions of one graft on other patients, instead of discarding the remaining materials, they save them, apply them to another patient, and then bill each patient’s insurance as though they received a brand-new graft.
To make matters worse, some fraudulent providers go beyond simply reusing the materials. They might:
- Inflate billing codes to falsely claim that a larger-sized graft was used.
- Submit claims for services that were never performed, pocketing the Medicare reimbursement.
- Allow uncredentialed providers to perform procedures using another doctor’s National Provider Identifier (NPI) to mask the fraud.
- Waive co-insurance to entice patients while illegally billing Medicare for the full amount.
This illegal behavior exploits trust, wastes taxpayer dollars, and most importantly, compromises patient care. Patients who receive reused grafts may not fully benefit from the treatment, putting them at risk of complications. Meanwhile, false claims filed under the False Claims Act (FCA) and illegal kickbacks violated under the Anti-Kickback Statute (AKS) drive up costs for everyone.
How to Spot Skin Graft Fraud at Your Workplace
You might be wondering, “Would I even know if this type of podiatry wound care fraud was happening?” The answer is yes—if you stay diligent and watch for red flags.
Often, the people most likely to notice suspicious practices are healthcare workers directly involved in patient care or medical billing. Medical assistants, nurses, nurse practitioners, billing associates, and even case managers are often the first to see where a provider might be cutting corners.
Red Flags to Watch For
There are a few tell-tale signs you should keep an eye on in your workplace, such as:
- Medical Documentation. Look closely at patient records. Does the documentation match what was actually done? Are partial grafts being misrepresented or left entirely undocumented?
- Billing Mistakes. Keep track of what’s being billed. Are claims indicating that full grafts were used for patients, even though smaller portions were applied? Are there discrepancies in the coding that could suggest upcharges?
- Storage Practices. Skin grafts are single-use items. If you notice materials being improperly stored, such as leftover grafts in storage facilities, it could indicate they’re being misused or reused.
- Patient Complaints. If patients consistently report that treatments are not working as intended or that their wounds aren’t healing as expected, this could reflect substandard care resulting from potential fraud.
- Waiving Co-insurance. Waiving co-insurance might seem harmless, but it’s often used to entice patients and can violate medical billing laws. You might notice this if staff routinely bypass financial responsibility for certain patients without proper documentation.
- Targeting Medicare Patients. Doctors or administrators may focus on Medicare patients due to the program’s higher reimbursement rates. Look for unusual patterns, such as a disproportionate number of Medicare claims or marketing efforts that specifically target these patients.
What to Do If You Suspect Podiatry Wound Care Fraud
Recognizing podiatry fraud is the first step, but what do you do next? Reporting fraudulent activities might feel intimidating, but you won’t have to do it alone. There’s a clear and supportive process to follow, and legal protections are in place to safeguard healthcare employees who come forward with information.
1. Document the Evidence
Stay observant and gather supporting documents that back up your suspicions. This might include:
- Billing records showing improper codes.
- Medical records with suspicious documentation.
- Emails or communications discussing questionable practices.
Remember, it’s crucial to maintain confidentiality while collecting this information.
2. Maintain Confidentiality
Speaking of confidentiality, resist the urge to share your concerns with coworkers, supervisors, or anyone outside of a trusted legal advisor. Discussing potential fraud openly could not only jeopardize an investigation, but also potentially put you at risk.
3. Consult a Whistleblower Attorney
Reporting fraud takes time and patience, which is why working with experienced attorneys, like those at DJO Whistleblower Law Firm, is essential. We’ll guide you through each step of the process, from filing a claim to ensuring your rights are fully protected.
4. Take Swift Action
Filing a whistleblower claim also comes with a potential monetary reward under the False Claims Act. Being the first to report fraud makes you eligible for up to 30% of any recovered funds if the case is successful. Acting quickly ensures your case is given priority, while minimizing further harm to patients and taxpayers.
Witnessed Healthcare Fraud at Work?
Fraudulent practices, like skin graft harvesting, harm patients, waste valuable resources, and compromise the integrity of the healthcare industry. Recognizing and reporting these unethical behaviors can protect patient care and ensure justice is served.
If you’ve seen evidence of podiatry fraud or podiatry wound care fraud in your job, there’s no time to lose. Reporting suspicious practices helps safeguard others and could also qualify you for a substantial whistleblower reward of up to 30% of any funds recovered by the government.
Contact DJO Whistleblower Law Firm today for a free and confidential consultation. Your voice could make all the difference for patients, taxpayers, and the healthcare system we all depend on.
authored by Christopher J. Piacentile
Director of Investigations DJO Whistleblower Law Group
