A Maryland physician was acquitted of a more than $15 million fraud scheme conviction after the court determined prosecution did not provide enough evidence that "ambiguous" CPT codes were being abused, law firm Husch Blackwell reported on JD Supra Dec. 29.
Ron Elfenbein, MD, 49, owned First Call Medical Center and Chesapeake ERgent Care, which operated multiple drive-thru COVID-19 testing sites. He instructed employees, in addition to billing for COVID-19 tests, to bill for high-level evaluation and management visits, according to an Aug. 4 Justice Department news release. Dr. Elfenbein ordered the high-level visits to be billed for all patients, including those who were asymptomatic, getting tested for their employment requirements or being tested so that they could travel, according to the release. Dr. Elfenbein was accused of submitting false claims for tens of thousands of high-level visits that were ineligible for reimbursement.
A federal jury convicted Dr. Elfenbein on five counts of healthcare fraud in August, but the federal judge who presided over the trial granted acquittal Dec. 21 in response to a motion filed by Dr. Elfenbein, according to Husch Blackwell's report.
The judge said that the prosecution did not offer enough evidence in the case to clear up the ambiguity around billing level 4 E/M codes. The court was clear that the Justice Department has been successful in prosecuting defendants who took advantage of the CPT codes, but that in this case the prosecution failed to do so.