A federal jury convicted a New York man Wednesday in an over $600 million health care fraud, wire fraud, and identity theft scheme, according to officials.
According to the evidence, Mathew James, 54, of East Northport, operated a medical billing company that billed for procedures that were either more serious or entirely different than those James’ doctor-clients performed.
James directed his doctor-clients to schedule elective surgeries through the emergency room so that insurance companies would reimburse at substantially higher rates.
When insurance companies denied the inflated claims, James impersonated patients to demand that the insurance companies pay the outstanding balances of tens or hundreds of thousands of dollars.
The defendant stands convicted of carrying out an audacious scheme in which he used insurance companies like ATM machines.
He stole hundreds of millions of dollars until 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.
“Health care fraud, including fraudulent billing schemes like this, costs U.S. taxpayers tens of billions of dollars annually. These crimes impact all of us in many ways, including increased health insurance premiums, greater out-of-pocket expenses and copayment amounts for medical treatment, and reduced or lost benefits, just to name a few,” said Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division.
James was convicted of conspiracy to commit health care fraud, health care fraud, three counts of wire fraud, and three counts of aggravated identity theft.
He is scheduled to be sentenced at a later date and faces up to 10 years in prison for health care fraud conspiracy, up to 10 years in prison for health care fraud, up to 20 years in prison for each of three wire fraud counts, and a two-year mandatory minimum each for three aggravated identity theft counts, officials stated.
The FBI investigated the case.
Acting Assistant Chief Miriam Glaser Dauermann of the Criminal Division’s Fraud Section and Assistant U.S. Attorneys Catherine Mirabile and Antoinette Rangel of the Eastern District of New York are prosecuting the case.