Doctor convicted for COVID-19 health care fraud scheme

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A federal jury in Baltimore convicted a Maryland doctor Friday for submitting more than $15 million in false and fraudulent claims to Medicare and a commercial insurer for patients who received COVID-19 tests at his testing sites.

According to court documents and evidence presented at trial, Ron Elfenbein, 49, was an owner and the medical director of Drs ERgent Care LLC, dba First Call Medical Center and Chesapeake ERgent Care.

Justice Department officials say Drs ERgent Care operated multiple drive-through COVID-19 testing sites where employees billed for high-level evaluation and management visits. In reality, these visits were not provided to patients as represented. Rather, Elfenbein instructed his employees that the patients were “there for one reason only – to be tested,” that it was “simple and straightforward,” and that the providers were “not there to solve complex medical issues.”

Elfenbein ordered these high-level visits to be billed for all patients, including those who were asymptomatic, who were getting tested for COVID-19 for their employment requirements, and who were being tested for COVID-19 so that they could travel. Elfenbein, through Drs ERgent Care, caused the submission of millions of dollars in claims to Medicare and a commercial insurer for tens of thousands of high-level visits that were not provided as represented and were ineligible for reimbursement, according to officials.

The jury convicted Elfenbein of five counts of health care fraud. He is scheduled to be sentenced on Nov. 7 and faces a maximum penalty of 10 years in prison on each count. Elfenbein is the first doctor convicted at trial by the Justice Department for health care fraud in billing for office visits in connection with patients seeking COVID-19 tests. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division; U.S. Attorney Erek L. Barron for the District of Maryland; Special Agent in Charge Maureen Dixon of the the Department of Health and Human Services Office of Inspector General (HHS-OIG); Special Agent in Charge Christopher Dillard of the Department of  Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Mid-Atlantic Field Office; Special Agent in Charge Thomas Sobocinski of the FBI Baltimore Field Office; and Deputy Assistant Inspector General for Investigations Conrad J. Quarles of the Office of Personnel Management Office of the Inspector General (OPM-OIG) made the announcement.

The HHS-OIG, DCIS, FBI, and OPM-OIG investigated the case.

Trial Attorney D. Keith Clouser of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Matthew P. Phelps for the District of Maryland are prosecuting the case.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, comprised of 15 strike forces operating in 25 federal districts, has charged more than 5,000 defendants who collectively have billed the Medicare program for more than $24 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.

In the past three years, the Health Care Fraud Strike Force has rooted out health care fraud related to the COVID-19 pandemic. To date, 53 defendants have been charged in nationwide COVID-19 Health Care Fraud Enforcement Actions for causing over $784 million in loss associated with the pandemic, including this case.