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Medical Biller Sentenced for Insurance coverage Fraud; Posed as Sufferers, Together with NBA Participant



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A medical biller has been sentenced to 12 years in federal jail after being convicted in an enormous insurance coverage fraud scheme that concerned posing as an NBA participant and different sufferers to harangue the businesses for funds that weren’t truly due, prosecutors stated.


U.S. District Decide Joanna Seybert referred to as Matthew James’ actions “inexcusable” as she sentenced him Friday in Central Islip, Newsday reported.

“To spoil individuals’s reputations, to do all that, for wealth is absolutely one thing,” Seybert stated.


James, 54, was convicted in July 2022 of fraud and identification theft fees. Prosecutors say he bilked insurance coverage corporations out of a whole bunch of tens of millions of {dollars}.

James ran medical billing corporations. Prosecutors stated he received some medical doctors to schedule elective surgical procedures by way of emergency rooms — a tactic that boosted insurance coverage reimbursement charges — and billed for procedures that have been completely different from those truly carried out. When insurance coverage corporations rejected the claims, he referred to as, pretending to be an outraged affected person or policyholder who was going through an enormous invoice and demanding that the insurer pay up.


One of many individuals he impersonated was NBA level guard Marcus Sensible, who received hand surgical procedure after hitting an image body in 2018, in line with court docket papers filed by James’ legal professionals.

Sensible was then with the Boston Celtics, the place he gained the NBA defensive participant of the yr award in 2022 — the primary guard so honored in additional than a quarter-century. Sensible now performs for the Memphis Grizzlies.


Sensible testified at James’ trial that the impersonation upset him as a result of he wasn’t raised to deal with individuals the best way James did, and that he was involved it will harm his standing as a job mannequin, in line with prosecutors’ court docket papers.

One other sufferer was NFL lawyer and government Jeff Pash, whose spouse was handled for an harm she received whereas operating in 2018. Jurors at James’ trial heard a recording of somebody who presupposed to be Pash — however truly was James — hollering and swearing at a customer-service consultant on an insurance coverage supplier’s devoted line for NFL workers, Newsday reported on the time.


“These are folks that work for the NFL, and I’d hate to have them suppose that was me on that decision,” Pash testified, saying he knew nothing about it till federal brokers advised him.

James’ lawyer, Paul Krieger, stated in a court docket submitting that James labored as a nurse earlier than beginning his personal enterprise in 2007. James developed a ingesting downside lately as he got here underneath stress from his work and household tasks, together with caring for his mother and father, the lawyer wrote.


“He sincerely and deeply regrets his misguided cellphone calls and communications with insurance coverage corporations by which he pretended to be sufferers in an effort to maximise and expedite funds for the real medical providers supplied by his doctor-clients,” the legal professional added, saying the calls have been “an aberration” within the lifetime of “a caring and first rate individual.”

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