Dr. Ron Elfenbein

Emergency physician, Gambrills, Maryland. Ran one of the state’s first COVID testing operations and its busiest monoclonal antibody center. The trial judge acquitted him on all counts. He is being tried again.

The case is about $250

Each of the five counts covers a single patient visit in 2021. The dispute is whether those visits should have been billed as Level 4 office visits or something lower. The difference the government alleged comes to roughly $50 a visit.

The Justice Department’s press release announcing his conviction described a scheme involving more than $15 million in false and fraudulent claims. The counts he was convicted on total about $250.

No patient in this case was fictitious. Every one was a real person who filled out registration paperwork, had vitals taken, took two COVID tests, saw a licensed provider face to face, and received follow-up with results and isolation guidance. Expert witnesses at trial testified the care was medically necessary and appropriate. The government alleged in its indictment that the services were not medically necessary, then put on no evidence at trial that they weren’t.

What the trial judge found

Judge Bredar did not rule that the jury was confused. He ruled that the government had failed to prove a crime occurred at all.

“Under the relevant law, the Defendant is not guilty, and he will be discharged.” Chief Judge James K. Bredar, 21 December 2023

The opinion found the coding guidance unquestionably ambiguous, particularly in the conditions of a pandemic in which the rules were being rewritten repeatedly. It found that the evidence supported the conclusion that Level 4 billing was permitted, and that no evidence had been presented to show otherwise. And it held that a citizen cannot be convicted of a crime for reading a technical regulation the way it can reasonably be read.

“The Government sails in shallow waters when it prosecutes a case of this type; these cases require careful navigation.” Chief Judge James K. Bredar, 21 December 2023

What the record shows about how this case was built

1. The government’s only expert had not read the rules he was called to explain. On cross-examination he retracted testimony and acknowledged he was unaware of interim rules and guidance issued during the pandemic — the documents that governed the exact question the jury was asked to decide.
2. Undercover agents were sent into his clinics. Dr. Elfenbein’s defense team learned during discovery that federal agents had gone into the clinics undercover during the investigation. None was called as a witness and nothing they found was put before the jury.
3. The medical necessity theory was charged and then abandoned. The indictment alleged the visits were not medically necessary. At trial the government presented no evidence of that, and every expert who testified — including the government’s own witnesses — confirmed the care was real and appropriate.
4. The public number and the charged number were not the same number. The press release said more than $15 million. The counts of conviction totalled about $250. The first figure is what the public read; the second is what he was convicted of.
5. The prosecution followed his public criticism by four months. In December 2021 Dr. Elfenbein publicly challenged the decision to halt monoclonal antibody distribution, on Fox News and elsewhere, saying people would die because of it. In April 2022 he was charged. Six weeks after that he received the Maryland State Medical Society’s highest individual honor. The sequence is a matter of record; readers can weigh it.

Who has asked the Justice Department to end it

The American Medical Association and the Maryland State Medical Society filed jointly as friends of the court in the Fourth Circuit in support of Dr. Elfenbein. The AMA writes the coding manual the government accused him of violating.

Since then, MedChi has written to the Acting Attorney General transmitting that brief and urging a just resolution. The Association of American Physicians and Surgeons has urged no second prosecution on double jeopardy grounds. The Independent Medical Alliance has called for prosecutorial restraint and dismissal. Former Maryland Governor Robert L. Ehrlich, Jr. has written personally on his behalf. The America First Policy Institute has written to the Department about the prosecution.

Before any of this, the State of Maryland had already honored him: a citation from Governor Larry Hogan in June 2021, a citation from the Maryland State Legislature in August 2021, and the Maryland State Medical Society’s Distinguished Member Award in May 2022.

What is still contested

The Fourth Circuit reinstated the jury’s verdict, holding a reasonable jury could have found as it did. The government maintains the billing was fraudulent and is entitled to retry him. Nothing on this page has been adopted by an appellate court.

What is not contested is the shape of it. A physician who was asked by federal and state government to open a treatment center, and honored for it, was charged four months after criticizing federal COVID policy, over five patient visits and roughly $250. The judge who sat through the trial found no crime. Five years later he is going back to court.

1. United States v. Elfenbein, Crim. No. JKB-22-0146 (D. Md.), Memorandum Opinion of 21 December 2023 granting judgment of acquittal.
2. Brief of the American Medical Association and MedChi, The Maryland State Medical Society, as amici curiae, U.S. Court of Appeals for the Fourth Circuit, 7 October 2024.
3. United States v. Elfenbein, U.S. Court of Appeals for the Fourth Circuit, July 2025.
4. Letters to the Acting Attorney General from MedChi (17 July 2026), the Association of American Physicians and Surgeons (17 July 2026), and the Independent Medical Alliance (19 June 2026).
5. Case background and documents: dropthecase.com.