Skin substitutes and biologic implants have become one of the fastest-growing cost drivers for health plans, with Medicare spending increasing more than 50-fold in six years and projected to exceed $13 billion. As utilization expands across outpatient settings, complex billing rules, percent-of-charge carve-outs, unit variability, and contract misalignment are driving hidden payment risk. This article explains how claim-level analytics, clinical validation, and contract-aware auditing help health plans identify overpayments, manage emerging risk, and maintain reimbursement accuracy as this category continues to grow.

Medical coding errors and flawed audit systems quietly add a “hidden tax” to healthcare—driving higher premiums, increased out-of-pocket costs, and strained provider reimbursements. In this insight, Dr. Robert Haskey explains how medical audits work, why fraud, waste and abuse remain so costly, and how outdated, opaque audit models fail to prevent errors at the source. He outlines a better path forward: deeper, clinically grounded audits that focus on root-cause prevention, provider education, and smarter use of human expertise and technology to make payment accuracy a shared responsibility across the healthcare system.