On August 4, 2023, the U.S. Department of Justice (DOJ) announced the conviction of a doctor involved in a COVID-19 healthcare fraud scheme. The case highlights the abuse of government programs during the COVID-19 pandemic and the government’s continued its efforts to investigate and pursue individuals and businesses that defrauded the government, particularly during the pandemic.
According to the press release, Dr. Ron Elfenbein was found guilty of participating in a fraudulent scheme to exploit the COVID-19 pandemic for personal gain. According to the government, the scheme involved submitting false claims to various government healthcare programs for COVID-19-related services that were never rendered or were unnecessary. Dr. Elfenbein owned Drs ERgent Care LLC, which operated multiple drive-through COVID-19 testing sites. The press release explains that Dr. Elfenbein instructed employees of Drs ERgent Care to bill for both the COVID-19 tests administered and for high-level evaluation and management (E/M) visits. The government noted, however, that the patients never received services to justify E/M billing.
Dr. Elfenbein was convicted of five counts of healthcare fraud for submitting “$15 million in false and fraudulent claims to Medicare and a commercial insurer for patients who received COVID-19 tests at his testing sites.” He faces up to 10 years in prison for each count. A federal judge will determine the sentence after considering the Federal Sentencing guidelines.
The government’s enforcement actions have continued since the Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law in March 2020. The CARES Act, through several programs and allowances, provided relief to businesses and individuals hurt by the COVID-19 pandemic. According to the government, “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.”
The attorneys at Chilivis Grubman represent clients of all types and sizes in connection with white-collar criminal investigations and healthcare fraud investigations. If you need assistance with such a matter, please contact us today.