In a significant victory for the fight against healthcare fraud during the COVID-19 pandemic, a Maryland doctor has been convicted after a three-week trial for his involvement in a healthcare fraud scheme. Ron Elfenbein, M.D., was found guilty on five counts of healthcare fraud for submitting over $15 million in false and fraudulent claims to Medicare and other insurers. This marks the first conviction by the Justice Department for health care fraud related to office visits in connection with COVID-19 testing. Elfenbein owned and operated multiple COVID-19 testing sites and instructed his employees to bill for high-level evaluation and management visits that were not provided to patients. He now faces a maximum sentence of 10 years in federal prison for each count of healthcare fraud.
Overview of the case
The case centers around the conviction of Ron Elfenbein, M.D., a doctor from Arnold, Maryland, who has been charged with healthcare fraud. Elfenbein is accused of submitting over $15 million in false and fraudulent claims to Medicare and other insurers for patients who received COVID-19 tests at sites operated by him.
Introduction to Ron Elfenbein, M.D.
Ron Elfenbein, M.D., is a 49-year-old physician who owned and operated Drs ERgent Care, LLC, in Anne Arundel and Prince George’s Counties in Maryland. He is accused of running a fraudulent healthcare scheme that involved billing insurers for high-level evaluation and management visits that were not actually provided to the patients.
Summary of charges
Elfenbein has been convicted on five counts of healthcare fraud. These charges stem from his submission of false and fraudulent claims to Medicare and other insurers for services that were not rendered. The total amount of these claims exceeds $15 million.
Importance of the conviction
Elfenbein’s conviction is significant due to the nature of the fraud scheme and the amount of money involved. This case serves as a warning to others who may be involved in similar fraudulent practices, highlighting the government’s commitment to combat healthcare fraud and protect taxpayers and patients.
The trial lasted for three weeks, during which the prosecution presented evidence supporting the charges against Elfenbein. The jury carefully considered this evidence before delivering its verdict.
Verdict and conviction
After three weeks of trial, the federal jury reached a verdict and found Elfenbein guilty on all five counts of healthcare fraud. This conviction marks an important step in holding accountable those involved in fraudulent healthcare practices.
Elfenbein’s sentencing has been scheduled for November 7, 2023, at 4:00 p.m. The court will consider various factors, including the severity of the offenses and any prior criminal history, in determining an appropriate sentence for the convicted doctor.
Potential consequences for Elfenbein
Elfenbein faces a maximum sentence of 10 years in federal prison for each of the five counts of healthcare fraud for which he has been convicted. The court will also likely order financial restitution and other penalties to hold him accountable for his actions.
Description of Fraud Scheme
Ownership and operation of Drs ERgent Care
Elfenbein owned and operated Drs ERgent Care, LLC, which operated drive-through COVID-19 testing sites in Maryland. This facility served as the center of his fraudulent healthcare scheme.
Drive-through COVID-19 testing sites
Elfenbein’s drive-through COVID-19 testing sites were primarily established to provide testing for individuals who required it for employment or travel purposes. These sites became a crucial part of his fraudulent scheme.
Billing for high-level evaluation and management visits
Despite the primary purpose of the drive-through sites being COVID-19 testing, Elfenbein instructed his employees to bill not only for the tests but also for high-level evaluation and management visits. These visits were falsely represented on claims submitted to insurers.
Misrepresentation to patients
Elfenbein misled his patients by instructing his employees that the visits were solely for the purpose of COVID-19 testing. He emphasized simplicity and discouraged complex medical evaluation, effectively misrepresenting the nature of the visits to patients.
Claims submitted to Medicare and other insurers
Elfenbein and Drs ERgent Care submitted false and fraudulent claims to Medicare and other insurers, totaling over $15 million. These claims were for the high-level evaluation and management visits that were not actually provided to the patients.
Total amount of false and fraudulent claims
The total amount of false and fraudulent claims submitted by Elfenbein and Drs ERgent Care exceeds $15 million. This substantial figure underscores the extent of the fraudulent scheme and the financial impact on the healthcare system.
Potential Impact on Patients
Patients’ reasons for seeking COVID-19 tests
Many patients sought COVID-19 tests at Elfenbein’s drive-through sites due to employment requirements or travel restrictions. These individuals depended on accurate and reliable testing facilities to comply with these obligations.
Elfenbein’s fraud scheme also affected asymptomatic patients who were seeking COVID-19 tests for various reasons. These individuals relied on reputable medical professionals to conduct accurate testing and provide necessary guidance.
The false claims and fraudulent practices of Elfenbein and Drs ERgent Care have implications for individuals who needed COVID-19 tests for employment purposes. The accuracy and integrity of testing practices are crucial for maintaining safe workplaces.
Individuals who required COVID-19 tests for travel purposes were also impacted by Elfenbein’s fraudulent scheme. Reliable testing and honest medical evaluation are paramount to ensure the safety of travelers and prevent the spread of the virus.
10 years in federal prison per count
Each count of healthcare fraud for which Elfenbein has been convicted carries a maximum sentence of 10 years in federal prison. The severity of the charges reflects the seriousness with which the legal system views healthcare fraud.
Calculation of potential total sentence
Given that Elfenbein has been convicted on five counts of healthcare fraud, the potential total sentence he may face could amount to 50 years in federal prison. The court will consider the circumstances of the case and any mitigating factors before determining the final sentence.
Acknowledgment of Agencies
United States Attorney for the District of Maryland
The United States Attorney for the District of Maryland, Erek L. Barron, played a crucial role in prosecuting Elfenbein and securing the conviction. Barron’s dedication to upholding justice and protecting the rights of the public is commendable.
Assistant Attorney General, Justice Department’s Criminal Division
Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division has been instrumental in overseeing the healthcare fraud prosecution and ensuring that justice is served. His commitment to upholding the law has been evident throughout this case.
Department of Health and Human Services Office of Inspector General (HHS-OIG)
The Department of Health and Human Services Office of Inspector General (HHS-OIG) contributed significantly to the investigation of Elfenbein’s fraudulent healthcare scheme. Their diligent work helped bring about this conviction and protect the integrity of federal healthcare programs.
Department of Defense Office of Inspector General, Defense Criminal Investigative Service – Mid-Atlantic Field Office
The Department of Defense Office of Inspector General, Defense Criminal Investigative Service – Mid-Atlantic Field Office played a pivotal role in uncovering Elfenbein’s fraudulent activities. Their collaboration with other agencies was crucial in building a strong case against him.
FBI Baltimore Field Office
The FBI Baltimore Field Office worked tirelessly to investigate Elfenbein’s healthcare fraud scheme. Their dedication and expertise were instrumental in collecting the necessary evidence to support the charges and secure a conviction.
Office of the Inspector General (OPM-OIG)
The Office of the Inspector General (OPM-OIG) provided valuable contributions to the investigation of Elfenbein’s fraudulent activities. Their efforts were crucial in bringing justice to those affected by his healthcare fraud scheme.
Reporting Suspected Fraud
National Center for Disaster Fraud (NCDF)
To ensure the public’s assistance in reporting suspected fraud, the National Center for Disaster Fraud (NCDF) can be contacted at (866) 720-5721. This center is responsible for reviewing and referring complaints related to fraudulent activities to the appropriate investigative agencies.
For individuals who suspect healthcare fraud and wish to report it, multiple agencies and resources are available. Contact information for these agencies can be found on their respective websites or by searching online.
Online complaint filing
The National Center for Disaster Fraud (NCDF) provides an online complaint filing service to streamline the reporting process. This online platform ensures that complaints are received promptly and can be reviewed by appropriate authorities.
Commendation to Investigative Agencies
The efforts of the Department of Health and Human Services Office of Inspector General (HHS-OIG) in investigating Elfenbein’s healthcare fraud scheme deserve commendation. Their commitment to protecting federal healthcare programs and ensuring the integrity of the healthcare system is commendable.
The Department of Defense Office of Inspector General, Defense Criminal Investigative Service – Mid-Atlantic Field Office’s collaboration and expertise in investigating Elfenbein’s fraudulent activities are commendable. Their work helps safeguard taxpayer funds and maintain the integrity of federal healthcare programs.
The FBI Baltimore Field Office’s dedication and professionalism in investigating Elfenbein’s healthcare fraud scheme are worthy of commendation. Their contributions were essential in gathering the necessary evidence to support the charges and secure a conviction.
The Office of the Inspector General (OPM-OIG)’s diligent efforts in uncovering Elfenbein’s fraudulent activities deserve recognition. They played a crucial role in bringing about justice and protecting the public from fraudulent healthcare practices.
Assistant U.S. Attorney Matthew P. Phelps
Assistant U.S. Attorney Matthew P. Phelps was responsible for prosecuting the case against Elfenbein. His knowledge and dedication were instrumental in presenting a compelling case to the jury, resulting in the doctor’s conviction.
Trial Attorney D. Keith Clouser
Trial Attorney D. Keith Clouser from the Justice Department’s Fraud Section also played a crucial role in prosecuting the case against Elfenbein. His expertise in healthcare fraud and commitment to justice were evident throughout the proceedings.
Resources for Community
Information on the Maryland U.S. Attorney’s Office
For more information on the Maryland U.S. Attorney’s Office, the public can visit their official website. This resource provides detailed information about the Office’s mission, history, and available resources.
Priorities of the Maryland U.S. Attorney’s Office
The Maryland U.S. Attorney’s Office has outlined its priorities to address various legal and law enforcement issues within the state. Understanding these priorities can help the community better comprehend the Office’s commitment to upholding justice.
The Maryland U.S. Attorney’s Office offers various resources designed to assist the community. These resources can provide valuable information and support to individuals affected by healthcare fraud or seeking guidance on related legal matters.