A New York man has been sentenced to 12 years in prison and ordered to pay over $336 million in restitution for an elaborate 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 Feb. 2 news release from the Justice Department.
Mr. James would also have physicians schedule elective surgeries in emergency rooms so that payers would provide higher reimbursements. If the claim was disputed, he would impersonate the patient during communications with the insurance company to get the claim approved.
One of the people he impersonated was NBA point guard Marcus Smart, formerly with the Boston Celtics and currently playing for the Memphis Grizzlies, NBC New York reported.
Mr. James was convicted by a federal jury in July 2022.