Saint James Man Convicted of $600M Health Insurance Fraud

Dollar bills on table with stethoscope on them
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A Saint James man was convicted of scamming health insurance companies out of more than $600 million by fraudulently padding medical bills, conspiring with doctors, and impersonating patients.

A jury found Mathew James guilty Wednesday of wire fraud and aggravated identity theft charges but acquitted him of money laundering charges following a six-week-long trial at Central Islip federal court.

“He used  insurance companies like ATM machines,” said Breon Peace, U.S. Attorney for the Eastern District of New York. “He was finally exposed by a paper trail a mile-long, phone recordings on which he  impersonated patients, and text messages and emails with his co-conspirator doctor clients  demonstrating his nefarious billing practices.”

Prosecutors said the 54-year-old man used his medical billing companies that primarily served plastic surgeons nationwide to defraud insurance companies by submitting claims to insurance companies for procedures that were either more serious or entirely different than those his doctor-clients performed. 

He also made thousands of calls impersonating patients, including Jeff Pash, the National Football League’s general counsel, and Marcus  Smart, a professional basketball player for the Boston Celtics, authorities said. 

In addition, he directed his doctor-clients to schedule elective surgeries through the emergency room so that insurance companies would reimburse at substantially higher rates, according to investigators. 

He will be sentenced by U.S. District Judge Joanna Seybert at a later date.