A Maryland doctor who was one of 18 people indicted in April 2022 as part of a nationwide crackdown on COVID-19-related fraud has been convicted on five counts of healthcare fraud.
According to court documents and evidence presented during trial, between March 2020 and December 2021, Ron Elfenbein submitted more than $15 million in false and fraudulent claims to both Medicare and commercial insurers for patients who received COVID tests at one of several testing sites he owned and operated under the name Drs ERgent care d/b/a First Call Medical Center and Chesapeake ERgent Care. Drs ERgent care operated drive-through COVID- 19 testing sites in two Maryland counties.
Elfenbein allegedly instructed the employees of Drs ERgent care to bill for higher-level evaluation and management visits for patients who were simply coming for COVID tests.
Doctor Accused of Gaming the System
In reality, those higher-level visits were never performed and the providers at those testing sites were told that they were “not there to solve complex medical issues.†In addition to billing for the COVID-19 test, the employees were told to bill for moderately complex office visits, lasting between 30 and 39 minutes for existing patients and between 45 and 59 minutes for new patients, even though Elfenbein knew that the visits lasted five minutes or less.
The indictment reads: “Elfenbein instructed providers and other employees of Drs ERgent Care to submit claims for these lucrative E/M Services because the higher complexity E/M Services were “the ‘bread and butter’ of how we get paid . . . a 99202 pays way less than a 99204.â€
“The indictment alleges that Ron Elfenbein took advantage of a national health crisis to line his own pockets,” said United States Attorney for the District of Maryland Erek L Barron.
First Doctor Convicted at Trial in COVID Case
Elfenbein, who is the first doctor convicted at trial by the Justice Department for healthcare fraud in billing for office visits in connection with patients seeking COVID-19 tests is scheduled to be sentenced on Nov. 7. He faces a maximum penalty of 10 years in prison on each count.
In May 2021, the Justice Department announced a coordinated law enforcement effort to combat healthcare fraud related to COVID.
Last year’s crackdown in which Elfenbein was indicted involved a total of $149 million in false billings to federal programs and theft from pandemic assistance programs. In connection with the enforcement action, the department seized more than $8 million in cash and other fraud proceeds.
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