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

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

In a detailed, 90-page ruling, James K. Bredar, chief judge of the U.S. District Court for the District of Maryland, said the government failed to meet the requirement to convict Dr. Ron Elfenbein, the Arnold emergency room physician accused of supplying the $15. with a million fraudulent tests in the emergency centers he manages.

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

Bredar noted that the move was rare, but said the government did not present enough evidence to make an indisputable conclusion that Elfenbein, an early proponent of testing for the deadly infection, miscoded those tests and billed Medicare and other insurance companies for reimbursements he was not required to pay. .

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In this context, taking advantage of loose definitions or a clear loophole is no more a crime than using it when preparing citizens’ tax returns, Bredar stated in his statement. Citizens, including health care providers, cannot be held criminally liable for doing only what a technical regulation is reasonably read to permit, even if it appears to benefit them excessively.

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

He also received a temporary contract to run an urgent care facility that offered tests at Baltimore-Washington International Thurgood Marshall Airport. For that work, he was awarded by the then government. Larry Hogan.

Drs ERgent Care is no longer in business. The Elfenbeins’ attorney, Martin S. Himeles Jr., said he expects Elfenbeins to work toward having his medical license fully reinstated and return to emergency medicine. He has held privileges at several Eastern Shore and Southern Maryland hospitals.

The Maryland Board of Physicians still lists his license as active, although it noted in August at the time of his sentencing that his enrollment in the Maryland Medicaid program was terminated. Elfenbein was threatened with a prison sentence of up to 10 years.

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We are happy that our client, who we have known from the beginning to be innocent, has now been convicted of his innocence, Himeles said.

He has lived too long under the cloud of government indictments and investigations, and the court’s opinion, in a very clear, comprehensive and thorough way, states that the government’s evidence simply does not establish his guilt, he said. She can now return to what she loves, helping patients who need her help, compassion and support.

A new trial is not automatically granted. The government would have to appeal the matter and apply for a new trial.

Rod Rosenstein, a former U.S. attorney from Maryland before becoming an assistant attorney general in the Trump administration, appears to be questioning the move to a new trial. He was not involved in the Elfenbein case.

Judge Bredar’s opinion is a tour de force, he said. This case sends a strong message to leaders of the U.S. Attorney’s Office and the Justice Department’s Criminal Division that they should be suspicious of prosecuting people for violating vague federal regulations. Sometimes things are handled better with civilian supervision.

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The US attorney had no comment.

Baltimore Banner reporter Justin Fenton contributed to this article.

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

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