Health Care Fraud

“Health care fraud is not a victimless crime, because fraudulent billing ultimately affects consumers who must pay the cost of higher insurance premiums.”

-United States Attorney Peace.

The Department of Justice’s press release discussed a federal jury on Long Island returned a guilty verdict on eight counts of charges against Mathew James. He perpetrated a $600 million health care fraud scheme which also included wire fraud and aggravated identity theft charges. Defendant impersonated patients to fraudulently inflate claims.

As proven at trial, James operated medical billing companies to provide billing services for physicians, primarily plastic surgeons throughout the United States, and used his companies to carry out a massive scheme to defraud insurance companies.

“The defendant stands convicted of carrying out an audacious scheme in which he used insurance companies like ATM machines.  He stole hundreds of millions of dollars until he was finally exposed by a paper trail a mile-long, phone recordings on which he impersonated patients, and text messages and emails with his co-conspirator doctor clients demonstrating his nefarious billing practices. For this massive fraud, a federal jury convicted him today,” stated Pence.