EAST NORTHPORT, N.Y. (WRIC) — A federal jury convicted a man in a $600 million health care fraud, wire fraud and identity theft scheme.
On Wednesday, July 13, 54-year-old Mathew James of East Northport, New York, was convicted of eight crimes: conspiracy to commit health care fraud, health care fraud, three counts of wire fraud, and three counts of aggravated identity theft.
He operated a medical billing company that billed for procedures that were either more serious or completely different than those his doctor-clients performed, according to court documents and evidence presented at the trial.
This case was investigated by the FBI.
James would direct his doctor-clients to schedule elective surgeries through the emergency room so that insurance companies would reimburse at much higher rates. When the insurance companies would deny the inflated claims, James impersonated patients to demand that the insurance companies pay the outstanding balances of tens or hundred of thousands of dollars.
“The defendant stands convicted of carrying out an audacious scheme in which he used insurance companies like ATM machines,” Kenneth Polite Jr., Assistant Attorney General of the Justice Department’s Criminal Division, said.
James’ sentencing is scheduled to take place at a later date. He faces up to 86 years in prison.