A Maryland doctor ran drive through COVID-19 testing sites in Anne Arundel and Prince George's counties.

He instructed the employees of Drs ERgent Care that, in addition to billing for the COVID-19 test, the employees were to bill for high-level evaluation and management visits.

Many of these patients were asymptomatic, were getting tested for COVID-19 for their employment requirements, or who were getting tested for COVID-19 so that they could travel. Elfenbein, through Drs ERgent Care, submitted or caused the submission of claims totaling more than $15 million to Medicare and other insurers for these high-level office visits.

Elfenbein was convicted by a jury.

https://www.thechesapeaketoday...-for-covid-19-tests/

then a judge tossed out the jury conviction.

In a detailed, 90-page ruling, James K. Bredar, chief judge of the U.S. District Court for Maryland, said the government did not meet the bar to convict Dr. Ron Elfenbein, an Arnold emergency room doctor who was charged with submitting $15 million in fraudulent tests at urgent care centers he operated.

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

Bredar noted that the move was rare but said the government didn’t present enough evidence to conclude beyond a reasonable doubt that Elfenbein, an early proponent of testing for the deadly infection, was improperly “upcoding” those tests and billing Medicare and other insurers for reimbursement he wasn’t due.

“In this context, it is not a criminal offense to take advantage of loose definitions or an explicit loophole any more than is it to do so when citizens prepare their tax returns,” said Bredar in the opinion. “Citizens, including healthcare providers, cannot be held to criminal account for doing only what a technical regulation is reasonably read to permit, even if to do so would seem to benefit them excessively.”

Elfenbein had not been practicing in any emergency department since he was charged last year with five counts of health care fraud for testing done through his company, Drs ERgent Care, which operated First Call Medical Center and Chesapeake ERgent Care in Anne Arundel and Prince George’s counties.

Drs ERgent Care is no longer operating. Elfenbein’s attorney, Martin S. Himeles Jr., said he expects Elfenbein to seek to have his medical license fully restored and to return to emergency medicine. He has had privileges at various Eastern Shore and Southern Maryland hospitals.

https://www.thebaltimorebanner...BWJA7PIUWVD75DZXUXY/

this just smells bad

Fraud during the COVID epidemic? Shirley, you jest!

What I find strange is the the government prosecuted this case. Was there a strait laced person who started this whom they couldn’t tamp down so they had to go through the motions???

And the judge’s reasoning for throwing out the case isn’t wrong; it just explains how so much money is being lost.

The Medical Board yanked his license which means they were skeptical of his operation. Granted he is getting the license restored, it is still a black mark on his record. In my mind the Prosecutor failed in his job as this appears to be fraud. Is Medicare asking to have the funds returned?

I am no expert, but it seems that billing for "high level evaluation and management" when all they did was a Covid test, that sounds like clear fraud. For $ 15 million.



https://prognocis.com/most-com...ical-billing-errors/

Upcoding – For some specialties, you’re dealing with complex cases and that makes it more efficient to report a high level evaluation and management code. While that’s fine, you have to document exactly why the coding was used so that you’re not using a higher level code than is appropriate.

From what has been reported so far, I wouldn't trust the judge.