Grothman Leads Roundtable on Tackling Medicare Fraud in Skin Substitutes Funding

WASHINGTON-Subcommittee on Health Care and Financial Services Chairman Glenn Grothman (R-Wis.) delivered opening remarks at today's roundtable titled "Medicare Fraud: Examining the Explosive Growth in Skin Substitute Spending." In his statement, Subcommittee Chairman Grothman highlighted the 7,100 percent spike in Medicare claims for skin substitute procedures in the last six years despite these procedures being medically unnecessary for many patients, suggesting a persistent pattern of waste, fraud, and abuse. He also emphasized that the purpose of this roundtable is to understand how and why Medicare became vulnerable to such dramatic spending growth, analyze whether recent reforms have been sufficient, and discuss any additional steps Congress and federal agencies should take to protect patients while ensuring responsible providers and manufacturers can continue delivering innovative care.

Below are Subcommittee Chairman Grothman's remarks as prepared for delivery:

Welcome to today's roundtable of the Subcommittee on Health Care and Financial Services.

Today, we are discussing rampant fraud involving skin substitutes in wound care.

Around two weeks ago, I was honored to attend a press conference with the White House Task Force to Eliminate Fraud, led by Vice President JD Vance.

At the press conference, Vice President Vance and CMS Administrator Dr. Oz detailed a shocking-and deeply troubling-7,100 percent spike in Medicare claims for skin substitute procedures over the past six years.

Skin substitutes are biosynthetic or tissue-derived wound coverings applied to treat severe burns, surgical defects, and chronic wounds.

Some of our nation's most vulnerable patients rely on these products. It is no accident, therefore, that these patients are often among the most susceptible to those who wish to profit off of them.

Skin substitute fraud is highly concentrated in assisted living facilities and skilled nursing facilities.

Recent investigations by the Department of Justice, the Department of Health and Human Services Office of Inspector General, and the Centers for Medicare & Medicaid Services have revealed alarming patterns of fraud, waste, and abuse in this space.

In some cases, providers billed Medicare for medically unnecessary skin substitute procedures, repeatedly applying products with little or no documented clinical benefit.

In other cases, providers submitted claims for services that were never even provided.

The growth in Medicare payments on skin substitutes has been staggering. Between 2019 and 2025, public spending increased from $200 million dollars to $14.4 billion dollars.

This raised serious questions about whether existing reimbursement policies created incentives that bad actors were able to exploit.

While the overwhelming majority of healthcare providers seek to serve patients ethically and responsibly, the mass fraud we have witnessed in the skin substitute market demonstrates how loopholes in payment systems can attract those looking to profit at the expense of taxpayers and beneficiaries.

Fortunately, the Trump administration has put a stop to this excessive billing.

CMS has implemented significant reimbursement reforms aimed at eliminating incentives that contributed to excessive spending, while the Department of Justice has pursued enforcement actions against individuals and entities alleged to have engaged in fraudulent conduct.

These efforts are important not only for protecting taxpayer dollars, but also for preserving access to legitimate and clinically appropriate wound care treatments.

That is the purpose of today's roundtable.

We want to better understand how these fraud schemes operate, why Medicare became vulnerable to such dramatic spending growth, whether recent reforms are sufficient, and what additional steps Congress and federal agencies should take to protect patients while ensuring responsible providers and manufacturers can continue delivering innovative care.

I appreciate our participants being here today to share their expertise. I look forward to a thoughtful and productive discussion.