A New York man was sentenced to 12 years in prison for orchestrating a scheme to defraud health insurance companies, the U.S. Justice Department said.
Mathew James was convicted of healthcare fraud, conspiracy to commit healthcare fraud, wire fraud, and aggravated identity theft in 2022. He operated companies to provide billing services primarily for orthopedic surgeons and plastic surgeons throughout the U.S.
Through the company, Mr. James billed for procedures that were more serious or completely different from what was performed, the Justice Department said Feb. 3. Some elective procedures would be scheduled through the emergency room to induce higher reimbursement rates.
Mr. James also impersonated surgeons, patients and their families — including an NBA player, according to The Washington Post — to convince insurance companies to reconsider denied claims or pay more.
Along with his prison sentence, he was ordered to pay more than $336 million in restitution.