Judge overturns Maryland doctor’s conviction for millions in health care fraud

A federal judge has taken the unusual step of throwing out a jury that convicted a prominent Maryland doctor of submitting millions of dollars in fraudulent insurance claims for COVID-19 tests.

In a detailed 90-page ruling, James K. Bredar, chief judge of the US District Court for Maryland, said the government did not meet the bar to convict Dr. Ron Elfenbein, an Arnold emergency room doctor charged with submitting $15 million in fraudulent tests to the urgent care centers he managed.

He is among several people charged by the US Department of Justice with fraud during the coronavirus pandemic, but is the first to be convicted of fraud related to the trial.

Bredar said the move was rare but said the government had not presented enough evidence to conclude beyond a reasonable doubt that Elfenbein, an early proponent of testing for the deadly infection, was improperly upgraded those tests and billed Medicare and other insurers for payments he didn’t owe. .

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In this context, it is not a criminal offense to take advantage of loose definitions or an outright loophole than it is to do so when citizens prepare their tax returns, Bredar said in the opinion. Citizens, including health care providers, cannot be held criminally liable for merely doing what a technical regulation is reasonably read to permit, even if doing so appears to greatly benefit them.

Elfenbein has not practiced in any emergency department since he was charged last year with five counts of health care fraud for testing done through his company, Drs ERgent Care, which operates First Call Medical Center in Chesapeake ERgent Care in Anne Arundel and Prince Georges counties.

He was also given a temporary contract to operate an urgent care center that offers testing at Baltimore-Washington International Thurgood Marshall Airport. For that work, he was awarded a citation by Gov. Larry Hogan.

Drs ERgent Care is no longer operational. The Elfenbeins’ attorney, Martin S. Himeles Jr., said he expects Elfenbein to seek full reinstatement of his medical license and return to emergency medicine. He had privileges at various hospitals on the Eastern Shore and Southern Maryland.

The Maryland Board of Physicians still lists his license as active, though it noted in August, at the time of his sentencing, that his enrollment in the Maryland Medicaid Program had been terminated. Elfenbein faces up to 10 years in prison.

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We are glad that our client, who we knew from the beginning was innocent, has now been proven innocent, Himeles said.

He has been living under the cloud of government charges and investigations for too long, and the court’s opinion in a very clear, comprehensive and thorough way found that the evidence presented by the government not only established his guilt, he said. He can now go back to what he loves to do, that is, helping patients who need his help and compassion and support.

A new test will not be automatically given. The government has to file an appeal and ask for a new trial.

Appearing to be skeptical of moving for a new trial is Rod Rosenstein, a former US attorney from Maryland before becoming an assistant attorney general in the Trump administration. He was not involved in the Elfenbein case.

Judge Bredar’s opinion was a tour de force, he said. This case sends a strong message to the leaders of the US Attorneys Office and the Justice Departments Criminal Division that they should be wary of prosecuting people for allegedly violating vague federal regulation. Sometimes cases are better handled in civil enforcement.

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The US attorneys office had no comment.

Baltimore Banner reporter Justin Fenton contributed to this article.

Meredith Cohn is a health and medicine reporter for The Baltimore Banner, covering the latest research, public health developments and other news. He’s been covering the beat in Baltimore for over two decades.

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