Mathew James, a 54-year-old resident of East Northport, New York, has been sentenced to 12 years in prison and ordered to pay over $336 million in restitution for masterminding a sophisticated health insurance fraud scheme. James, along with co-conspirators, including physicians nationwide, manipulated claims and defrauded multiple health insurance companies, securing hundreds of millions of dollars through deceptive practices. Court documents revealed that James operated medical billing companies, submitting fraudulent claims for plastic or orthopedic surgeons. The scheme included billing for exaggerated or entirely different procedures and involved James impersonating patients to influence insurance companies, resulting in tens of millions in additional proceeds. The elaborate fraud extended to directing doctors to schedule surgeries through the emergency room for higher reimbursement rates. James was convicted on charges including health care fraud, conspiracy, wire fraud, and aggravated identity theft.
The sentencing announcement was made jointly by Acting Assistant Attorney General Nicole M. Argentieri, U.S. Attorney Breon Peace for the Eastern District of New York, and Assistant Director in Charge James Smith of the FBI New York Field Office. The FBI investigated the case, and the prosecution was led by Trial Attorney Miriam Glaser Dauermann and Assistant U.S. Attorneys Catherine Mirabile and Antoinette Rangel, with Assistant U.S. Attorney Tanisha Payne handling asset forfeiture in the Eastern District of New York.
SOURCE: JUSTICE GOV | JFEBRUARY 05 2024
FOR COMPLIANT GLOBAL
INTELLIGENCE REPORTS,
RISK ASSESSMENTS,
COMPLEX INVESTIGATIONS
& CYBERSECURITY.
