A $250 Billing Dispute, a $15 Million Indictment, and a 93-Page Acquittal - Dr. Ron Elfenbein

In June 2021, Maryland’s governor handed Dr. Ron Elfenbein a personal citation for his pandemic work. Ten months later the federal government indicted him for the same work. He was convicted, then acquitted by the chief judge in a 93-page opinion, then had that acquittal reversed on appeal — and he’s now awaiting retrial. He joins JP Maroney and co-host Stephen Keller to walk through how a disagreement over a billing code became a federal criminal case.

Full show notes

Dr. Ron Elfenbein ran what became Maryland’s largest private COVID-19 testing operation — from six employees to eight sites and more than 300 staff in about fourteen months. He set up monoclonal antibody infusion centers in rented volunteer ambulance halls, partnered with HHS on a site at FedEx Field, and says his practice tested more than 300,000 people and infused over 5,000.

He was also loud. In December 2021, after the federal government wound down the monoclonal antibody program, Elfenbein went on Fox News and said the decision would cost lives. He repeated it on Newsmax. Four months later — to the day, he says — he was indicted on federal health care fraud charges.

The case came down to a coding question. Prosecutors focused on five patient encounters out of more than 100,000 in the relevant window, arguing the visits were billed at a Level 4 evaluation and management code when a lower level applied. Elfenbein puts the per-visit difference at roughly $50. The government extrapolated across the practice’s claims and put the figure at $15 million.

A jury convicted him on five counts in August 2023. Four months later, Chief Judge James K. Bredar — an Obama appointee — granted a judgment of acquittal in a 93-page opinion, finding the government had not carried its burden, and conditionally granted a new trial in case the acquittal was reversed. The government appealed. In July 2025 the Fourth Circuit affirmed the new-trial order but reversed the acquittal, and the case was remanded. Judge Bredar has since recused himself without stated explanation.

In this conversation, Elfenbein describes what he believes drove the prosecution, what happened at trial, and what two and a half years of it did to his practice, his finances, and his four children. Stephen Keller — who lived through his own federal case and wrote Pay to Play about it — presses him on what the pattern looks like from the outside, and on whether anything can protect physicians from it.

A note on what’s in this episode: Dr. Elfenbein makes strong claims about the efficacy of monoclonal antibody treatment, about federal pandemic policy, and about the motivations of the prosecutors and agencies involved. Those are his accounts and his conclusions. Several are contested, and some are disputed in the court record itself — including whether false documentation was at issue at trial. We present his account because the procedural history of this case is unusual enough to warrant a full hearing, not because we’ve independently verified every claim in it. The Fourth Circuit’s published opinion is United States v. Elfenbein, 144 F.4th 551 (4th Cir. 2025). Judge Bredar’s opinion is available at dropthecase.com. Read both.

Chapters

• 0:00 — Introductions: JP Maroney, co-host Stephen Keller, and Pay to Play on the shelf behind the guest
• 1:50 — Governor’s citation in June 2021, legislative citation in August, federal indictment in April 2022. Same work. What changed?
• 2:18 — Medical Society names him Person of the Year after the indictment
• 4:58 — Building the operation: six employees to eight sites and 300+ staff in fourteen months
• 5:40 — The DEA asks him for PPE the federal government can’t obtain
• 6:39 — Watching Trump receive monoclonals at Walter Reed, and teaching himself infusion medicine
• 7:58 — Renting volunteer ambulance halls, buying pumps and chairs, becoming the largest regional supplier
• 9:48 — Partnering with HHS on the FedEx Field site
• 10:41 — Federalized distribution and the “equity” allocation fight
• 12:00 — Florida buys its own supply; DeSantis and the mid-Atlantic shortage
• 13:49 — The program shuts down. He goes on Fox News and says people will die.
• 14:45 — The Omicron prevalence number: 70% claimed, 20% conceded
• 18:10 — His theory of why a working treatment was a problem: the emergency use authorization
• 19:22 — The indictment: five patient charts out of more than 100,000
• 20:39 — Why he says this should have been an administrative chart audit, not a prosecution
• 23:46 — The arithmetic: a ~$50 code difference, five charts, a $15 million allegation
• 24:48 — How extrapolation turned five charts into every patient
• 27:05 — Trial: the government’s expert, impeached on day one
• 28:06 — Judge Bredar from the bench: “shoot first and ask questions later”
• 28:36 — The defense expert — a past president of the AAPC — reviews hundreds of charts
• 29:32 — Proving criminal intent with tax returns
• 30:21 — The closing argument: don’t follow the rules, use your common sense
• 31:48 — Conviction. Then, three months later, the 93-page acquittal.
• 33:13 — The government appeals. The judge later recuses himself with no explanation.
• 41:43 — The Fourth Circuit: collapsing falsity into intent
• 44:05 — The coding table, the third column, and what the appellate panel focused on
• 46:14 — Stephen Keller: medical billing as a loaded revolver pointed at physicians
• 48:22 — Selective and vindictive prosecution — and the AMA, which wrote the rules, filing in his defense
• 51:09 — Why is this still moving under a new administration?
• 51:25 — The February 2025 DOJ memo and a weaponization task force he says never convened
• 53:28 — The road not taken: treat-the-vulnerable versus vaccinate-everyone
• 55:55 — Follow the money: 8.5 billion potential vaccine recipients versus perhaps 20 million treatment candidates
• 60:10 — “Find me one physician who spoke against the narrative and wasn’t beaten down”
• 61:04 — On “settled science”
• 63:18 — The process is the punishment: the business, the income, the children in therapy
• 65:31 — Coaching hockey at the Naval Academy, career day, and everything that stopped
• 67:34 — If it can happen to a president, why not to you?
• 68:29 — The background: Hopkins chief resident, Secret Service task force at the Salt Lake Olympics, a NASA grant for airway protocols in space
• 75:31 — What can physicians actually do to protect themselves?
• 77:42 — Keller and Elfenbein on state versus federal regulation of insurance
• 79:49 — Would DOJ dropping the case be justice, or just the end?
• 81:28 — The scuba diver, the net, and the endangered sharks
• 84:28 — The cost of physicians leaving insurance entirely
• 85:14 — The one institution never blamed for the opioid crisis
• 86:43 — Shining a light: JP on the tw…