Man gets 12 years in prison in insurance scheme after posing as patients, including NBA player
CENTRAL ISLIP, NY — A medical biller has been sentenced to 12 years in prison after being convicted of a massive insurance fraud scheme in which he posed as an NBA player and other patients to harass the companies for payments that were not actually due, prosecutors said.
U.S. District Judge Joanna Seybert called Matthew James’ actions “inexcusable” as she sentenced him Friday in Central Islip, Newsday reported.
“Ruining people’s reputations, all that, because wealth is a real thing,” Seybert said.
James, 54, was convicted in July 2022 of fraud and identity theft. Prosecutors say he cheated insurance companies out of hundreds of millions of dollars.
James ran medical billing companies. Prosecutors said he induced some doctors to schedule elective surgeries through emergency rooms — a tactic that increased insurance reimbursements — and charged for procedures that were different from those actually performed. When insurance companies denied the claims, he called, posing as an outraged patient or policyholder facing a huge bill and demanding that the insurer pay.
One of the people he impersonated was NBA point guard Marcus Smart, who underwent hand surgery after crashing into a picture frame in 2018, according to court documents filed by James’ lawyers.
Smart was then with the Boston Celtics, where he won the 2022 NBA Defensive Player of the Year award — the first guard to be so honored in more than a quarter-century. Smart now plays for the Memphis Grizzlies.
Smart testified at James’ trial that the impersonation upset him because he had not been raised to treat people the way James did and that he feared it would damage his position as a role model, according to prosecutors’ court documents .
Another victim was NFL attorney and executive Jeff Pash, whose wife was treated for an injury she suffered while running in 2018. Jurors at James’ trial heard a recording of someone posing as Pash — but actually James — shouting and cursing at a man. customer service representative on an insurance company’s dedicated line for NFL employees, Newsday reported at the time.
“These are people who work for the NFL, and I would hate for them to think that was me,” Pash testified, saying he knew nothing about it until federal agents told him.
James’ attorney, 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 became stressed by his work and family responsibilities, including caring for his children. parents, writes the lawyer.
“He sincerely and deeply regrets his deceptive phone calls and communications with insurance companies in which he posed as a patient in an effort to maximize and expedite payments for the genuine medical services provided by his physician clients,” the attorney added. were ‘an anomaly’ in the life of ‘a caring and decent person’.