A Billing Code 'Ambiguity' Retrial: 3 Things to Know

Healthcare attorney Andrew Solinger was quoted in a Law360 article about the retrial of Dr. Ron Elfenbein, a Maryland physician whose conviction in a COVID-19 billing fraud case was overturned as a result of ambiguity in medical billing codes. The article examined how the U.S. Court of Appeals for the Fourth Circuit's decision clarifies that ambiguous billing guidance does not automatically shield providers from liability under the False Claims Act (FCA) or criminal healthcare fraud statutes. Mr. Solinger highlighted that, according to the court, the presence of ambiguity alone does not foreclose the possibility of a violation, and it is ultimately up to the jury to decide how the guidance should be interpreted.

"Just because guidance is ambiguous doesn't mean you can't violate the False Claims Act in the civil context or criminal healthcare fraud statute in the criminal context," he said.

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