A medical biller has been sentenced to 12 years in federal prison after being convicted in a massive insurance fraud scheme that involved posing as an NBA player and other patients to harangue the companies for payments that werenB次元官网网址檛 actually due, prosecutors said.
U.S. District Judge Joanna Seybert called Matthew JamesB次元官网网址� actions B次元官网网址渋nexcusableB次元官网网址� as she sentenced him Friday in Central Islip, B次元官网网址day reported.
B次元官网网址淭o ruin peopleB次元官网网址檚 reputations, to do all that, for wealth is really something,B次元官网网址� Seybert said.
James, 54, was convicted in July 2022 of fraud and identity theft charges. Prosecutors say he bilked insurance companies out of hundreds of millions of dollars.
James ran medical billing companies. Prosecutors said he got some doctors to schedule elective surgeries via emergency rooms B次元官网网址� a tactic that boosted insurance reimbursement rates B次元官网网址� and billed for procedures that were different from the ones actually performed. When insurance companies rejected the claims, he called, pretending to be an outraged patient or policyholder who was facing a huge bill and demanding that the insurer pay up.
One of the people he impersonated was NBA point guard Marcus Smart, who got hand surgery after hitting a picture frame in 2018, according to court papers filed by JamesB次元官网网址� lawyers.
Smart was then with the Boston Celtics, where he won the NBA defensive player of the year award in 2022 B次元官网网址� the first guard so honored in more than a quarter-century. Smart now plays for the Memphis Grizzlies.
Smart testified at JamesB次元官网网址� trial that the impersonation upset him because he wasnB次元官网网址檛 raised to treat people the way James did, and that he was concerned it would damage his standing as a role model, according to prosecutorsB次元官网网址� court papers.
Another victim was NFL lawyer and executive Jeff Pash, whose wife was treated for an injury she got while running in 2018. Jurors at JamesB次元官网网址� trial heard a recording of someone who purported to be Pash B次元官网网址� but actually was James B次元官网网址� hollering and swearing at a customer-service representative on an insurance providerB次元官网网址檚 dedicated line for NFL employees, B次元官网网址day reported at the time.
B次元官网网址淭hese are people that work for the NFL, and I would hate to have them think that was me on that call,B次元官网网址� Pash testified, saying he knew nothing about it until federal agents told him.
JamesB次元官网网址� lawyer, Paul Krieger, said in a court filing that James worked as a nurse before starting his own business in 2007. James developed a drinking problem in recent years as he came under stress from his work and family responsibilities, including caring for his parents, the lawyer wrote.
B次元官网网址淗e sincerely and deeply regrets his misguided phone calls and communications with insurance companies in which he pretended to be patients in an effort to maximize and expedite payments for the genuine medical services provided by his doctor-clients,B次元官网网址� the attorney added, saying the calls were B次元官网网址渁n aberrationB次元官网网址� in the life of B次元官网网址渁 caring and decent person.B次元官网网址�
The Associated Press
