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

A federal judge has taken the unusual step of sentencing a prominent Maryland doctor for handing over millions of dollars in fraudulent insurance claims for COVID-19 tests.

In a detailed, 90-page order, Chief Judge James K. Breeder of the U.S. District Court for the District of Maryland said that the government had to pay Dr. Ron Elfenbein, an Arnold emergency room physician who was charged with handing over $15 , did not meet the bar for conviction. Millions of fake tests at the urgent care centers he runs.

He was one of several people charged by the U.S. Department of Justice with fraud during the coronavirus pandemic, but the first to be convicted of test-related fraud at trial.

Breeder noted that the move was rare but said the government had not presented enough evidence to conclude beyond a reasonable doubt that Elfenbine, the provider of pre-tests for the deadly infection, was improperly updating those tests and that Medicare and others Billing insurers for payments he didn’t make. .

In this respect, it is not a criminal offense to take advantage of loose definitions or obvious loopholes without doing so when citizens prepare their tax returns, Breeder said in the opinion. Residents, including health care providers, cannot be held criminally accountable just for doing what the technical regulations reasonably read, even if it appears that it would benefit them the most.

Elfenbein did not practice in any emergency department since he was indicted last year on five counts of health care fraud for tests performed through his company, Dr. ERgent Care, which owns First Cal Medical Center and Chesapeake ERgent Care. Operates in Anne Arundel and Prince Georges counties. .

He was also awarded a temporary contract to operate an urgent care center that offered testing at Baltimore-Washington International Thurgood Marshall Airport. For this work, he was awarded by the then Govt. Larry Hogan

Drs ERgent Care is no longer in business. Elfenbein’s attorney, Martin S. Hamels Jr., said he expects Elfenbein to try to fully restore his medical license and return to emergency medicine. He held privileges at various hospitals on the Eastern Shore and in Southern Maryland.

The Maryland Board of Physicians still lists his license as active, although it noted at the time of his sentencing in August that his enrollment in the Maryland Medicaid program had expired. Al-Finbin was imprisoned for up to ten years.

“We are pleased that our client, who we initially found innocent, has now been vindicated,” Hamels said.

He has lived under the cloud of the government’s accusations and investigations for a long time, he said, and the court’s opinion has found the evidence presented by the government to be very clear, comprehensive and complete, simply did not prove his guilt. He can now go back to what he loves, which is helping patients who need his help and compassion and support.

A new trial will not be automatically granted. The government should appeal and seek a new trial.

Appearing to cast doubt on the move for a new trial is Rod Rosenstein, a former U.S. attorney from Maryland before becoming an assistant attorney general in the Trump administration. He was not involved in the Al-Finbin case.

Judge Breders’ opinion is a tour de force, he said. The case sends a strong message to the U.S. Attorney’s Office and the heads of the Justice Department’s criminal division that they should be leery of prosecuting people accused of violating vague federal rules. Sometimes cases are better handled with civil enforcement.

The US Attorney General has not commented on this.

Baltimore Banner reporter Justin Fenton contributed to this article.

Meredith Cohen is a health and medicine reporter for The Baltimore Banner covering the latest research, public health developments and other news. He has been covering beats in Baltimore for over two decades.