A Long Island man who impersonated the general counsel of the NFL and an NBA player as part of his scheme for multiple frauds will now serve jail time. Sentenced in federal court in Central Islip, Matthew James used physicians throughout the country to bill health insurers fraudulently to the tune of hundreds of millions of dollars.
James operated companies that provided billing services for doctors’ offices. Using the billing platform as cover, he faked signatures and impersonated individuals in calls to insurance companies to inflate reimbursement payments.
James also advised his doctor clients to schedule surgeries that could have been elective and in-network to be performed in an emergency room under false emergency conditions, resulting in higher reimbursements. He also impersonated patients in calling their health insurance companies to appeal and demand payment for claims that were denied.
In addition to the prison time, James was ordered to pay restitution of $336 million and will forfeit another $63 million.
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