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The United States Attorney’s Office (USAO) announced 54-year-old East Northport resident Matthew James’ sentence for the scheme, during which he pretended to be both an NBA player and an NFL partner, on Friday, Feb. 2.
James was the operator of multiple medical billing companies that provided billing services for physicians throughout the United States, mainly plastic surgeons. As a third-party biller, James would submit claims to insurance companies when necessary and would request reconsideration or appeals for denied claims.
According to the USAO Eastern District of New York’s Office, James used these duties to orchestrate a “massive” scheme to defraud insurance companies.
The 54-year-old would bill for procedures that were either more serious or a completely different surgery than what his doctor-clients had performed.
As part of these fake bills, James made calls to exaggerate the medical procedures – once pretending to be Jeff Pash, the National Football League’s general counsel, and Marcus Smart, a professional basketball player then of the Boston Celtics of the National Basketball Association.
In all, the USAO’s Office said James made thousands of calls impersonating someone else, resulting in tens of millions of additional reimbursements to his clients, which he got a cut of.
When he was denied his inflated claims, James is said to have then impersonated the patients, calling the insurance companies and demanding they pay the outstanding balances.
He also advised his clients to schedule elective surgeries through the emergency room so that insurance companies would reimburse them at significantly higher rates.
James was sentenced to 10 years in prison for fraud charges, alongside two years for aggravated identity theft.
Additionally, he was ordered to pay $336,996,416.85 in restitution and forfeit another $63,382,049.02.
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