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Long Island resident Matthew James, age 54, of Saint James, appeared in US District Court in Central Islip on Wednesday, July 13, where he was found guilty on nine counts that included wire fraud and identity theft.
The verdict followed a six-week trial in which federal prosecutors laid out how James ran phony medical billing companies to defraud insurance companies of more than $600 million.
Working with his co-conspirator doctor clients around the United States, many of them plastic surgeons, James billed for procedures that were either more serious or entirely different than those his doctor clients performed, prosecutors said.
He also impersonated patients, including NBA player Marcus Smart, of the Boston Celtics, in order to demand that insurance companies pay outstanding balances, some of which totaled in the tens or hundreds of thousands of dollars.
To boost his profits, James would often encourage his doctor clients to schedule elective surgeries through the emergency room so that insurance companies would reimburse at significantly higher rates, according to prosecutors.
For his efforts, James received a percentage of the additional reimbursements.
“The defendant stands convicted of carrying out an audacious scheme in which he used insurance companies like ATM machines,” US Attorney Breon Peace said in a statement.
“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 is not a victimless crime, because fraudulent billing ultimately affects consumers who must pay the cost of higher insurance premiums.”
James will be sentenced at a later date.
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