They told them not to, but they did it anyway.
Right there in the contract, the U.S. government specifically told the company not to hit the billing code that made it look like a patient was making progress healing, even if no healing was really going on. But the California company, Kinetic Concepts, Inc., went ahead and billed that way and collected millions from the government this way.
A whistleblower, Steven Hartpence, came forward to show what the company was up to. But the company claimed it thought it was doing the right thing and the government approved of the way it was billing.
Hartpence brought a False Claims Act case, claiming this amounted to fraudulent billing. The U.S. district court in Los Angeles agreed with the company and said no fraud was apparent.
But yesterday, in a published decision, the Ninth Circuit sided with the whistleblower and found that if the government knew that the company was billing in this manner, it would not have paid as requested.
Timothy Cornell, of Cornell Dolan, P.C., wrote and edited much of the brief, and helped prepare Mark Labaton, of Glancy, Prongay & Murray, for oral argument.