05/18/2026    Brian Kashan, DPM

UT Podiatrist Charged With $29 Million Dollar Healthcare Fraud

Once again, podiatrists/physicians are being used
as the pawn in the chess game of medical supply
and pharmaceutical companies. This is nothing new,
but the stakes are getting higher with the
increased costs of drugs and products.

What is not new, are these companies refusing to
take on any risk, and make the lion's share of
profit. Without us, they have no business, but
they refuse to partner with us when it comes to
risk.

Years ago, when skin substitutes became available
I had asked the rep (from a well known and large
company) to share the cost risk with me. The
product was a thousand dollars or so, and the
application of it paid about $200. I asked that if
I wasn’t paid by the insurer, to not be charged
for the product. After all, they assure you that
it will never be a problem and you will be
reimbursed. Every company refused to partner in my
risk.

Now, with grafts and substitutes costing sometimes
tens of thousands, , if not hundreds of thousands
of dollars, they still wont take on any risk. We
have the risk of not being paid, of
overutilization, of fines, penalties and even
jail! Yet, because of the promise of a drug rep,
we jump on the bandwagon, go crazy applying these
products, and in 2 years have an audit and
recoupment, while the rep who sold you the product
is laying on the beach in the Bahamas sipping a
cold marguerita.

Does that mean we should stop using these
products? Of course not. But they should be used
wisely, expeditiously, and only when appropriate.
Less expensive products should be considered first
and more expensive products need to have
justification for their use. Document everything
in your LCD, as regions have different LCD's and
you want to be following the one in your
jurisdiction. And most importantly, scrutinize the
reps about everything. Ask for them to risk share,
even though you know they wont. Question why they
won't and put them on the spot. If all of us
demanded they take some of our risk, they would
have to do so or not sell any product outside the
hospital.

I've been in practice 43 years, and the names have
changed, but the game is still the same.

Brian Kashan, DPM, Baltimore, MD

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05/18/2026    Paul Kesselman, DPM

UT Podiatrist Charged With $29 Million Dollar Healthcare Fraud

Having previously spent a few decades applying CTP
to many patients, it is a shame what has
transpired over the past six years since I retired
from practice. We have no doubt killed a golden
goose. But gold is not referred to in a monetary
fashion for the graft reimbursement, per se, but
for what it was worth to the millions of patients
whose limbs and wounds were salvaged. The UT case
is only one http://podiatrym.com/go.cfm?n=16088

There is also a current case in which the DOJ has
alleged $29M in fraud for CTP from a Pasadena
Wound Care facility. http://podiatrym.com/go.cfm?
n=16089There are undoubtedly more.

There is so much blame to go around for this
massive problem.

Let’s start with the HCPCS common work group,
which traditionally rejects 85% or more
applications for new HCPCS codes. Over the last
decade, this committee, with medical directors and
scientists from a wide array of backgrounds, has
granted new codes to just about every applicant of
CTP. For some, with scant evidence of their
efficacy. There are more than 300 CTP on the
market with most having few clinical applications.
One has to wonder why that is the case and why
they still have active HCPCS codes? One should
also wonder why the same people who approved of
these 300 products are now screaming to curtail
them, claiming now that they are ineffective and
reducing the approved number to approximately 20.
Some manufacturers are claiming foul, alleging
that perhaps there is some inside influence which
left most products off the approved list and what
inside influence did those remaining have?.

Second are greedy physicians and graft
manufacturers and their sales representatives, as
was referred to Nejad, who may have brokered
outrageous agreements The amounts of money should
be troubling to anyone. For CTP spending to be an
estimated $250M, just seven years ago and reach
over $10B in 2024 is mind boggling. Applying these
expensive grafts to patients with little potential
for healing and to patients who have not already
exhausted standard wound care certainly needs to
be curtailed.

No one is forcing any physician to purchase X
numbers of CTP and apply them to every patient
that walks in the door, especially for
marginalized patients with minimal potential for
healing These grafts are far too expensive to be
used as front line therapy.

Third is the political climate which allowed a
rather well written although not perfect nation-
wide LCD to be dropped at the last minute. This
has left most of the country without a safety net
of an LCD. While LCD can sometimes be good or bad,
to discard a well written LCD, leaving wound care
providers with no safety net was appalling. At
least with an LCD you know where you stand.
Without an LCD medical necessity often becomes a
debate between the provider and the auditor. We
know who will almost always win that fight. The
provider, potentially losing hundreds of thousands
if not millions of dollars they have purchased.
This scenario does not appeal to many ethical
providers, who have now abandoned ship and have
removed CTP from their armamentarium.

Last: The experimental WISeR program, while its
effects are still unknown, should have been
implemented nationwide, but could not due to the
LCD removal. A similar prior authorization in DME
for certain AFO has worked very well with
affirmation rates remaining high for ethical
providers. Simultaneously, this has drastically
reduced the number of unethical providers from
providing specific services.

What will this whole debacle will cost in
alternative treatments which go way beyond
standard wound care is anyone’s guess. Will
autografting, use of HBO, topical oxygen,
hyperxoic oxygen, ultrasound, PRP, NPWT and other
sophisticated wound care treatments exceed the
$10B cost or will patients be left with no
alternatives, but limb amputation and the
morbidity costs associated post-amputation?

The answers to these questions may be elusive, but
our patients and all honest providers deserve
prompt answers. While honest providers may lose
out financially it our patients who may lose their
limbs and lives. That is far too costly for their
families and society to bear.

An upcoming wound care edition of Podiatry
Management will have an entire article dedicated
to this issue.

Paul Kesselman, DPM, Oceanside, NY