A New York man is facing the potential of nearly five decades in prison after a federal jury convicted him July 13 for an elaborate $600 million healthcare billing fraud, wire fraud and identity theft scheme.
Mathew James of East Northport, N.Y. operated a medical billing company that would submit claims to payers for services that were more complicated or completely different than the ones performed by his physician clients, according to a Justice Department news release.
Mr. James would have physicians schedule elective surgeries in emergency rooms so that payers would provide higher reimbursements. If the claim was disputed, Mr. James would impersonate the patient during communications with the insurance company to get the claim approved.
He was convicted of conspiracy to commit health care fraud, health care fraud, three counts of wire fraud and three counts of aggravated identity theft. He faces up to 40 years in prison, along with a two year mandatory minimum for each count of aggravated identity theft. No sentencing date was made public.