Proposed Verdict Form — United States v. Ron Elfenbein (D. Md., Dkt. 65, August 3, 2023)

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A Proposed Verdict Form filed August 3, 2023 as Document 65 in United States v. Ron Elfenbein, Crim. No. JKB-22-0146, in the U.S. District Court for the District of Maryland. A cover page states that the Court, after a conference with counsel, notifies counsel and the parties that it intends to use the attached verdict form, and that any objection must be noted before the Court formally instructs the jury. The signature block names James K. Bredar, Chief Judge. The form lists Counts One through Five, each labeled Health Care Fraud and each with a table of dates, payor and procedure code, with options of Guilty or Not Guilty for the Defendant. It ends with a line for the jury foreperson.

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Case 1:22-cr-00146-JKB Document 65 Filed 08/03/23 Page 1 of 4

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF MARYLAND

*

UNITED STATES OF AMERICA a
Vv. * CRIM. NO. JKB-22-0146
RON ELFENBEIN, *
Defendant. *
* * * * * * * * * * x x
PROPOSED VERDICT FORM

Having conducted a conference with Counsel, and the Court having considered and
discussed with Counsel their proposed verdict form,
THE COURT NOW NOTIFIES Counsel and the parties that it intends to use the verdict
form attached hereto. To the extent that Counsel or a party objects to any portion of the verdict
form attached hereto, they shall note such objection to the Court before the Court formally instructs

the jury.

Dated this > day of August, 2023.

BY THE COURT:

James K. Bredar
Chief Judge
Case 1:22-cr-00146-JKB Document 65 Filed 08/03/23 Page 2 of 4

IN THE UNITED STATES DISTRICT COURT
.FOR THE DISTRICT OF MARYLAND
(Northern Division)

UNITED STATES OF AMERICA

v. Crim. No. JKB-22-146
RON ELFENBEIN, |
Defendant.
VERDICT FORM
COUNT ONE (Health Care Fraud):
Beneficiary | Date of Date of Claim No. Payor Procedure
Submission of Service ' Code;
Claim Amount
Billed
A.H. 03/29/2021 03/25/2021 | 691021088249240 | Medicare | CPT 99204
What is your verdict as to the Defendant with regard to Count One of the Superseding
Indictment?
GUILTY - NOT GUILTY
COUNT TWO (Health Care Fraud):
Beneficiary | Date of Date of Claim No. Payor Procedure
Submission of Service Code;
Claim Amount
Billed
W.R. 05/03/2021 04/23/2021 | 691021123406780 | Medicare | CPT 99204

What is your verdict as to the Defendant with regard to Courit Two of the Superseding

Indictment?

GUILTY

NOT GUILTY
Case 1:22-cr-00146-JKB Document 65 Filed 08/03/23 Page 3 of 4

COUNT THREE (Health Care Fraud):

Beneficiary | Date of Date of Claim No. . Payor Procedure
Submission of Service Code;
Claim Amount
Billed
D.M. 05/12/2021 05/10/2021 | 691021132127230 | Medicare | CPT 99204
$354.22
What is your verdict as to the Defendant with regard to Count Three of the Superseding
Indictment? ,
GUILTY NOT GUILTY
COUNT FOUR (Health Care Fraud):
Beneficiary Date of Date of Claim No. Payor Procedure
Submission of Service ‘ Code;
Claim Amount
1: Billed
J.J. 03/05/2021 03/02/2021 | 372663924 CareFirst | CPT 99214
BCBS $231.50

What is your verdict as to the Defendant with regard to Count Four of the Indictment?

GUILTY NOT GUILTY
COUNT FIVE (Health Care Fraud):
Beneficiary | Date of Date of Claim No. Payor — Procedure
Submission of Service , Code;
Claim Amount
Billed
S.T. 04/28/2021 04/19/2021 | 327993824 CareFirst | CPT 99204 |.
BCBS $354.22

What is your verdict as to the Defendant with regard to Count Five of the Superseding

Indictment?

GUILTY

.NOT GUILTY
Case 1:22-cr-00146-JKB Document 65 Filed 08/03/23 Page 4 of 4

Upon my oath, the foregoing constitutes the unanimous verdict of the jury.

Signed this day of ’ , 2023:

JURY FOREPERSON


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