Lawmakers Urge CMS to Shield ACOs from Medicare Fraud Losses: Cite Skin Substitutes as a Key Focus

HMP Global November 20, 2025
Jennifer J. Spector, DPM, FACFAS

Key Clinical Summary

• Congressional leaders called on the Centers for Medicare and Medicaid Services (CMS) to mitigate Accountable Care Organizations’ (ACOs) financial exposure to Medicare fraud, waste, and abuse (FWA).
• The letter cites spikes in fraudulent skin substitute as one of the major threats to value-based care.
• Lawmakers urged CMS to exclude documented fraudulent claims from ACO financial benchmarks to preserve program integrity.

In a November 5, 2025, letter to Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz, MD (published on November 13, 2025), three members of Congress urged swift action to protect Accountable Care Organizations (ACOs) from the financial fallout of fraudulent Medicare claims. The bipartisan letter, led by Rep. Vern...

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