We have also worked within key Medicare oversight agencies such as:

• UPIC (Uniform Program Integrity Contractor)

• RAC (Recovery Audit Contractor)

• MAC (Medicare Administrative Contractor)

• OIG (Office of Inspector General)

This expertise is vital given Medicare’s growing scrutiny of the mobile wound care industry, especially with the increased use of advanced therapies like skin substitutes. As such, it’s critical for providers—Home Health agencies, Skilled Nursing Facilities, and physicians—to align with companies that understand the regulatory landscape to avoid audits, repayment demands, or exclusion from programs.

GOWC’s compliance team doesn’t just understand Medicare rules—we’ve enforced them. Our responsibilities include analyzing provider data trends, identifying billing vulnerabilities, selecting and directing claims audits, and performing audits.

Now, that same knowledge is used to protect GOWC operations and its referring partners from regulatory risk.GOWC builds its protocols to meet or exceed all applicable regulatory guidance, including:

• Local Coverage Determinations (LCDs)

• Local Coverage Articles (LCAs)

• CMS Program Integrity Manual (PIM)

The compliance team collaborates closely with the Director of Nursing to seamlessly integrate these standards into clinical workflows. Training for Nurse Practitioners is a cornerstone of the program, providing real-time support and education as well as guidance to ensure interventions are medically necessary, properly billed, and fully documented.

Additionally, all Nurse Practitioners are required to be wound care certified, reinforcing both clinical quality and regulatory compliance.

Every claim undergoes a pre-review by compliance experts for audit readiness. GOWC also closely monitors clinical outcomes and healing rates using key wound care metrics to ensure continuous quality improvement. Providers are trained to prioritize conservative care before advanced interventions and ensure each step is medically justified and appropriately timed.