Jury Convicts Person of $600 Million Overall health Treatment Fraud, Wire Fraud, and ID Theft Scheme | OPA

A federal jury convicted a New York guy today in an around $600 million health care fraud, wire fraud, and id theft scheme.

According to court docket documents and proof introduced at trial, Mathew James, 54, of East Northport, operated a healthcare billing enterprise that billed for treatments that were possibly far more major or totally different than these James’ medical professional-customers performed.  James directed his health practitioner-shoppers to program elective surgical procedures through the unexpected emergency space so that insurance plan organizations would reimburse at significantly greater rates. When insurance policies companies denied the inflated promises, James impersonated patients to need that the insurance policies organizations shell out the superb balances of tens or hundreds of 1000’s of dollars.

“James orchestrated a fraudulent clinical billing scheme to steal from insurance coverage providers and companies, in order to line his own pockets,” mentioned Assistant Legal professional Standard Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division. “This conviction reveals that professional medical billers who gas well being care fraud will be brought to justice.”          

“The defendant stands convicted of carrying out an audacious scheme in which he applied insurance policies providers like ATM equipment. He stole hundreds of thousands and thousands of dollars until finally he was ultimately exposed by a paper trail a mile-extensive, cell phone recordings on which he impersonated clients, and textual content messages and email messages with his co-conspirator physician consumers demonstrating his nefarious billing procedures. For this substantial fraud, a federal jury convicted him currently,” reported U.S. Attorney Breon Peace for the Japanese District of New York. “Health care fraud is not a victimless criminal offense, due to the fact fraudulent billing eventually affects buyers who should pay the expense of higher insurance policy premiums.”

“Health treatment fraud, together with fraudulent billing strategies like this, expenditures U.S. taxpayers tens of billions of pounds yearly. These crimes effects all of us in quite a few approaches, such as greater wellness insurance premiums, bigger out-of-pocket costs and copayment quantities for professional medical remedy, and minimized or lost benefits, just to identify a couple of,” claimed Assistant Director Luis Quesada of the FBI’s Prison Investigative Division. “The FBI, collectively with our legislation enforcement partners, is dedicated to rooting out overall health care fraud in all its sorts and bringing people who seek to exploit our wellbeing treatment system to justice.”

James was convicted of conspiracy to commit health and fitness care fraud, overall health treatment fraud, a few counts of wire fraud, and a few counts of aggravated identification theft. He is scheduled to be sentenced at a afterwards day and faces up to 10 a long time in prison for well being care fraud conspiracy, up to 10 several years in jail for health care fraud, up to 20 decades in jail for each individual of 3 wire fraud counts, and a two calendar year required minimum amount just about every for 3 aggravated id theft counts. A federal district court decide will decide any sentence immediately after thinking about the U.S. Sentencing Recommendations and other statutory elements.

The FBI investigated the scenario.

Acting Assistant Main Miriam Glaser Dauermann of the Criminal Division’s Fraud Section and Assistant U.S. Lawyers Catherine Mirabile and Antoinette Rangel of the Eastern District of New York are prosecuting the circumstance.

The Fraud Portion prospects the Criminal Division’s attempts to fight well being care fraud by way of the Wellbeing Treatment Fraud Strike Force Software. Due to the fact March 2007, this software, comprised of 15 strike forces running in 24 federal districts, has billed a lot more than 4,200 defendants who collectively have billed the Medicare system for far more than $19 billion. In addition, the Centers for Medicare & Medicaid Products and services, doing the job in conjunction with the Place of work of the Inspector Basic for the Division of Well being and Human Services, are taking steps to hold companies accountable for their involvement in wellness care fraud techniques. A lot more facts can be located at https://www.justice.gov/legal-fraud/overall health-treatment-fraud-device.