Wound Care: America's Billion-Dollar Bandage

In 2014, Medicare spent $135 million on wound care. By 2023, that number was $2.14 billion. Not billion with a typo. Billion with a B. That's a 1,485% increase in nine years — while the number of wound care providers barely changed. Same number of doctors. Fifteen times the money.

The top wound care provider in America — Ira Denny, a nurse practitioner in Surprise, Arizona — billed Medicare $135.2 million. For 90 patients. That's $1.5 million per patient. All of it in skin substitutes.

The Explosion Nobody Noticed

Look at that chart. Wound care spending barely moved from 2014 to 2019 — growing from $135M to $291M in five years. Then 2020 hit $446 million — a 53% jump in a pandemic year when most of Medicare was contracting. By 2021 it nearly doubled to $775 million. And 2023? $2.14 billion.

The number of wound care providers went from 11,746 to 13,141 over the entire decade — an 11.9% increase. The money went up 1,485%. Where is it all going?

Skin Substitutes: The $4 Billion Product

The answer is overwhelmingly skin substitutes — bioengineered tissue products applied to chronic wounds. These products, billed through Q-codes like Q4262 (Dual Layer Impax Membrane) and Q4253 (Zenith Amniotic Membrane), have become wound care's golden goose.

A single application of a skin substitute can cost Medicare $1,000 to $10,000+. Patients with chronic diabetic ulcers or venous leg wounds might receive applications every 1-2 weeks for months. At $5,000 per visit, a single patient can generate $100,000+ per year in skin substitute charges alone.

The Top Billers

The per-patient numbers are staggering. Ira Denny: $1.5 million per patient. Jorge Kinds: $1.3 million per patient. Carlos Ching: $952,985 per patient. All nurse practitioners. All in Arizona. All billing exclusively skin substitutes with a markup ratio of 1.28x.

The Beverly Hills Connection

Then there's Beverly Hills. Johnson Lee, a plastic surgeon billing from 90210, generated $31.8 million in wound care payments across 3,713 patients. The Comprehensive Outpatient Surgery Center in Beverly Hills billed $8.5 million with a jaw-dropping markup ratio of 11.43x.

Beverly Hills podiatrist David Pougatsch billed $4.0 million with a 13.1x markup. And Millicent Rovelo, another Beverly Hills plastic surgeon: $7.7 million for 1,248 patients.

The presence of Beverly Hills — not exactly known for its diabetic ulcer population — at the top of wound care billing raises questions about whether these are chronic wound patients or cosmetic procedures coded as wound care. We explored this in our Beverly Hills Wound Care investigation.

Top Procedure Codes

Wound debridement (11042) is the most common procedure at $1.1 billion across 23,242 providers — this is the bread-and-butter of wound care and relatively well-distributed. But the Q-codes for skin substitutes tell a different story: $834 million through just 141 providers for Q4262 alone. That's an average of $5.9 million per provider for a single product.

The Miramar, Florida Pattern

Scrolling through the data, one city name appears over and over: Miramar, Florida. Dozens of providers — family practitioners, general surgeons, OB-GYNs — all billing millions in wound debridement from the same ZIP code. Names like Bryant Koh ($3.5M), Thomas Vizinas ($3.5M), Hayriye Gok ($3.4M), and Qi Li ($3.4M) — all billing exclusively debridement with no skin substitutes and markups of 3-4x.

The Miramar cluster represents a different model than Arizona: high-volume debridement rather than high-cost skin substitutes. Both are lucrative. Both raise questions.

Why It Matters

Wound care is the fastest-growing segment of Medicare spending. A 1,485% increase in nine years dwarfs every other category — drug spending, telehealth, even COVID testing. And unlike those categories, wound care has no natural ceiling. Chronic wounds don't resolve. Patients keep coming back. Skin substitutes keep getting applied.

CMS has begun to take notice. In 2024, several skin substitute codes were repriced or bundled, and new prior authorization requirements were proposed. But the data through 2023 shows a system that had already spiraled far beyond any reasonable growth trajectory.

Explore Further

• Wound Care Fraud Dashboard — Explore all 500 top wound care providers
• Beverly Hills Wound Care — The 90210 connection