An 88-year-old woman living with dementia became the center of a disturbing story presented to Congress as lawmakers examined what they described as an explosion in Medicare spending on advanced wound-care products.
During a July 21 congressional roundtable on Medicare fraud and so-called “skin substitutes,” witnesses described the case of an elderly San Antonio woman referred to as “Maria.” According to testimony presented at the hearing, she received 12 skin-substitute applications over roughly 45 days — generating more than $10 million in Medicare claims.
The allegations become even more troubling when her overall care is considered. The testimony said Maria was homebound after suffering a stroke and had serious pressure wounds, yet during the period in question she allegedly received repeated wound-care procedures while receiving little or no other follow-up care. She died approximately two months after the treatments began.
Her case was presented as one example of a much larger problem.
Medicare Part B spending on skin substitutes increased from approximately $200 million in 2019 to more than $14.4 billion in 2025, according to the House Committee on Oversight and Government Reform — an increase of roughly 7,100% in only six years.
Lawmakers and witnesses said some providers have been accused of repeatedly applying expensive products without sufficient medical justification, while other investigations have involved claims for services that allegedly were never performed.
The hearing also examined how Medicare’s previous reimbursement system may have created enormous financial incentives. Certain products were reimbursed by the square centimeter, with some reportedly reaching thousands of dollars per square centimeter.
CMS has since changed how these treatments are reimbursed, including a much lower payment ceiling designed to reduce excessive spending and remove some of those incentives.
It is important to note that the $10 million figure represents Medicare claims associated with the patient’s care as described in congressional testimony — not necessarily $10 million ultimately paid to one provider. The patient’s identity was also withheld.
But the larger question raised in Washington remains difficult to ignore:
How could spending on one relatively narrow category of Medicare wound treatment climb from $200 million to more than $14 billion in only a few years?
Congress is now trying to find out how it happened — and how many vulnerable seniors may have been caught in the middle.
