Physician could get prison time for phony insurance claims related to COVID-19 tests

A physician could face prison for fraudulent insurance claims totaling more than $15 million for COVID-19 tests.

The U.S. Department of Justice (DOJ) announced the first doctor convicted by a jury for submitting false claims to Medicare and other insurers for COVID-19 testing at sites he operated.

Ron Elfenbein, MD, 49, of Arnold, Maryland, was convicted of five counts of health care fraud in the case. He is scheduled to be sentenced in November, according to DOJ.

Citing evidence from the trial, DOJ said Elfenbein owned and operated Drs ERgent Care LLC, doing business as First Call Medical Center and Chesapeake ERgent Care. The company operated drive-through COVID-19 testing sites in two counties in Maryland.

Many of the patients were asymptomatic and getting tested for work or travel. Along with COVID-19 tests, the company billed Medicare and a commercial insurer for “high-level evaluation and management visits,” according to DOJ.

“In reality, these visits were not provided to patients as represented,” the DOJ news release said. “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 faces a maximum sentence of 10 years in federal prison for each of the five counts, according to DOJ.

A news report in The Baltimore Banner described Elfenbein as “a prominent Maryland doctor who promoted early access to COVID-19 testing” during the pandemic, and who was awarded a citation from Maryland then-Gov. Larry Hogan for his work.

In that report, Elfenbein’s attorney, Martin S. Himeles Jr., said he was “very disappointed” in the trial outcome and that Elfenbein maintained his innocence. That report noted no other employees were charged in connection with the case.

DOJ announced the charges against Elfenbein with 14 other cases as part of a coordinated nationwide law enforcement action against COVID-19-related health care fraud, according to an April 2022 news release. At that time, attorneys for Elfenbein said the doctor’s efforts helped essential workers, including police, firefighters, and health care staff, to continue their work, according to a Maryland The Daily Record news report.