In June 2021, the governor of Maryland showed up at one of Ron Elfenbein’s testing sites with an entourage and handed him a signed proclamation for his pandemic work. In August, the state legislature, controlled by the other party, voted him a citation of its own. In April 2022, the federal government indicted him for health care fraud. The following month, the state medical society named him its person of the year anyway. The award still hangs behind his desk.
“Same work,” is how Elfenbein puts it. “What changed?”
His answer is blunt: he believes the Justice Department was turned against him for what he said on television. The government’s answer, on the record, is five patient charts and a billing code. Between those two accounts sits one of the stranger procedural histories in recent federal health care prosecution, and it is not over. Elfenbein told the story in a conversation recorded for The Justice Impact Show with host JP Maroney and co-host Stephen Keller.
Six employees to eight sites
Before the pandemic, Elfenbein ran a small urgent care with about six employees. Fourteen months later he had eight sites and more than 300 staff. His practice tested people, went into nursing homes, and gave away masks and protective equipment. Early on, he says, the special agent in charge of a Drug Enforcement Administration office called him personally because federal agents planning a bust in Annapolis could not get N95 masks, gowns, or face shields from their own government. Elfenbein packed a bag and the agent picked it up at his house that night.
In October 2020 he watched President Trump leave Walter Reed after being treated with monoclonal antibodies. Elfenbein is an emergency physician, trained at Johns Hopkins, where he served as chief resident. He treats gunshot wounds and strokes. He did not do infusions. So he taught himself. He rented empty catering halls from volunteer ambulance companies, bought chairs, infusion pumps and IV tubing, and had the state of Maryland certify the sites. By his account his practice became the largest supplier of monoclonal antibody treatment in Maryland and the mid-Atlantic, with patients driving down from New Hampshire. Over the course of the pandemic he says the operation tested more than 300,000 people and infused more than 5,000.
The federal government noticed. The Department of Health and Human Services asked him to help set up and run an infusion site at FedEx Field in Landover, a partnership between his company, HHS, and the Maryland Department of Health. He bought the equipment, staffed it, and ran it until the program ended.
In late 2021 the federal government took over distribution of the antibody supply. Elfenbein says that overnight, orders that had always been filled in full were cut. Then, in December 2021, the program was shut down entirely on the stated ground that the Omicron variant had reached 70 percent prevalence and the existing antibodies would not work against it.
Elfenbein went on Fox News and said people were going to die. He said it again on Newsmax with Sean Spicer. A month later, by his account, the government revised the Omicron figure from 70 percent to 20 percent and never apologized.
“I would argue that makes me a whistleblower,” he says. “I was a federal subcontractor for the federal government. I went on national television and said these people are going to kill people with their incompetence.”
Four months after the Fox appearance, he says to the day, a federal grand jury indicted him.
Five charts
The indictment did not allege phantom patients or services never rendered. Everyone agrees the patients were real, were seen, and were tested for COVID. The dispute is what evaluation-and-management code should have been billed for the visit.
Prosecutors identified five patient encounters out of the more than 100,000 the practice saw in the roughly eight-month window of the indictment. Elfenbein did not see those patients. His nurse practitioners and physician assistants did, and a third-party company handled the billing. He had circulated memos recommending a Level 4 code, which he still believes was correct. The government said a lower level applied.
He puts the difference between a Level 4 and a Level 3 at about $50 per visit, depending on the insurer. Five visits, $250. “So the United States government is trying to put me in jail for up to 550 years over a $250 billing dispute.”
The number in the government’s press materials was $15 million. That figure, he explains, came from extrapolating the five charts to every patient the practice billed in the window, and then asserting that the practice should have been paid nothing at all for any of them, even though it had seen and tested every one. Because medical practices typically collect about a third of what they bill, he says the business actually received about $5 million on those claims.
Nobody from the government ever called, emailed, faxed, or audited the charts before charging him, he says. That is the part that still gets him. If a grocery store overcharges you for pencils, he asks, do you go back to the register or do you call the Department of Justice?
Two weeks before trial, he says, prosecutors superseded the indictment to add two counts involving Blue Cross Blue Shield, because until then they had no insurer witness lined up to testify.
The case was assigned to Chief Judge James K. Bredar of the District of Maryland, an Obama appointee. At a pretrial conference, by Elfenbein’s account, the judge described the prosecution as “a case of shoot first and ask questions later.”
The government’s first witness was its billing expert. Elfenbein says the man had testified for the government in more than 150 cases, was an expert on Medicare rather than on coding, and had to retract portions of his testimony on cross-examination after being asked to read aloud from the coding manual. He says the judge sent the witness and the jury out of the room and asked prosecutors at the bench where the crime was.
The defense called a past president of the American Academy of Professional Coders, who reviewed hundreds of charts rather than five and testified they were coded correctly, some of them undercoded. To prove intent, Elfenbein says, the government put his business tax returns in front of the jury and pointed to how much more the practice earned during the pandemic than before it.
In closing, by his account, the prosecutor told jurors it did not matter what the right code was, that the defense expert’s rules were meant to confuse them, and that they should use their common sense. “Now, he happens to be right. It doesn’t make common sense,” Elfenbein says. “But those are the rules agreed upon by the United States government and all the insurance companies.”
In August 2023 the jury convicted him on all five counts.
“Worst day of my life. I really just wanted to die right then and there.”
Ninety-three pages
Months later, Judge Bredar issued a 93-page opinion granting a judgment of acquittal on every count, finding the government had not carried its burden. He also conditionally granted a new trial in case the acquittal was reversed on appeal.
Elfenbein calls it the best day of his life, ahead of his wedding and the births of his children, and says he slept through the night for the first time in three years. He reads from the opinion often. Among the lines he quotes: “The evidence weighs so heavily in favor of the defendant that it would be unjust to enter judgment against him.”
The government appealed. In July 2025 the Fourth Circuit affirmed the new-trial order but reversed the acquittal and sent the case back. The published opinion is United States v. Elfenbein, 144 F.4th 551 (4th Cir. 2025). Elfenbein’s reading of it is that both courts called his interpretation of the coding manual reasonable, and that the appellate panel nonetheless allowed the government to prove the falsity of a claim by proving intent, collapsing two elements he believes the law requires to be shown separately. He also says the panel fixed on the third column of a coding table that the experts at trial testified was immaterial, and that at oral argument prosecutors asserted charts had been falsified, something he says was never charged or raised at trial.
Not long after, Judge Bredar sent the parties a one-line notice recusing himself. No reason was given. Elfenbein has not spoken to him and has no explanation, though he has two theories: that someone got to the judge, or that the judge no longer trusted himself to be objective about a case he had already called unjust.
A word on what is contested. Elfenbein’s claims about how well monoclonal antibodies worked, why the federal government cut off the program, why prosecutors chose him, and what was or was not alleged at trial and on appeal are his conclusions. Several are disputed, including in the court record itself. The show notes for the episode say as much. The two documents that matter most are both public: the Fourth Circuit’s opinion and Judge Bredar’s opinion, which Elfenbein has posted at dropthecase.com. Read both.
What it cost
The business is gone. He could not work for two and a half years. He kept his three state medical licenses because the states, not the federal government, issue them. His wife, a pediatric oncologist, watched their life turn over. Of their four children, the youngest was three at the time of the indictment and still has not been told what happened. The three older ones, all straight-A students, went into therapy. One daughter slept between her parents for a year because she could not sleep anywhere else. Her father lay next to her staring at the ceiling.
Before the indictment he coached ice hockey at the Naval Academy, coached his kids’ soccer teams, volunteered for the Red Cross, and went to career day to talk about being a doctor. All of it stopped. He points out that the usual props of a fraud case are missing. He drives a Hyundai. His wife drives a beat-up Subaru.
“The process is the punishment,” he says. “They’re dragging you over these exposed razor blades that just slowly kill you.”
He also admits something about himself. Five years ago, he would have assumed anyone indicted by the federal government was guilty. Where there’s smoke, there’s fire. “Boy, was I naive and was I wrong.”
Where it stands
The case is set for retrial, which Elfenbein says is scheduled for January. He believes it should never have survived the change in administrations. He points to a February 2025 Justice Department memorandum on restoring the department’s integrity, which called for a task force to review weaponized prosecutions and listed whistleblowers among the cases to examine. He says he has been unable to find anyone in the department willing to look at his, and that the task force has never met. He says the American Medical Association, the Maryland State Medical Society and other physician groups have written to the department asking that the case be dropped and have filed briefs in his support, which he finds remarkable, since the AMA wrote the coding rules he is accused of breaking and he has never been a member.
Asked whether a dismissal would be justice or merely the end, he does not pretend. “There would be some semblance of justice,” he says. “But ultimately, no. Justice would be restoration of my reputation, restoration of the funds that were stolen from me, my business that was stolen from me.”
Then there is the question every physician in the room eventually asks him: how do I keep this from happening to me?
“Unfortunately, you really can’t,” he says. Billing and coding are a gray area, and he believes a Justice Department that wants a case can find one in any chart. His practical advice is to leave the insurance system entirely, and he concedes in the same breath what that would mean for the patients who depend on Medicare and cannot follow their doctors out the door. He sits on the board of Keller’s Justice Restoration Foundation, which he says is building something to help physicians who get blindsided. Beyond that, his warning is simple.
“I don’t even have a parking ticket to my name,” he says. “And it can happen to me.”