Saint James man found guilty of $600m health insurance fraud


A Saint James man has been convicted of defrauding health insurance companies of more than $600 million by fraudulently filling out medical bills, conspiring with doctors and posing as patients.

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

“He used insurance companies like ATMs,” said Breon Peace, U.S. Attorney for the Eastern District of New York. “He was eventually exposed through a mile-long paper trail, phone records on which he posed as patients, and text messages and emails with his co-conspiratorial physician clients demonstrating his practices of harmful billing.”

Prosecutors said the 54-year-old used his medical billing companies that primarily served the nation’s plastic surgeons to defraud insurance companies by submitting claims to insurance companies for more serious or entirely different procedures than those performed by his physician clients.

He also made thousands of calls posing as 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 ordered his physician-clients to schedule elective surgeries through the emergency room so insurance companies would reimburse at significantly higher rates, investigators say.

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


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