UNITED STATES NEWS

Man gets 12 years in prison in insurance scheme after posing as patients, including NBA player

Feb 3, 2024, 1:26 PM

CENTRAL ISLIP, N.Y. (AP) — A medical biller has been sentenced to 12 years in federal prison after being convicted in a massive insurance fraud scheme that involved posing as an NBA player and other patients to harangue the companies for payments that weren’t actually due, prosecutors said.

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

“To ruin people’s reputations, to do all that, for wealth is really something,” Seybert said.

James, 54, was convicted in July 2022 of fraud and identity theft charges. Prosecutors say he bilked insurance companies out of hundreds of millions of dollars.

James ran medical billing companies. Prosecutors said he got some doctors to schedule elective surgeries via emergency rooms — a tactic that boosted insurance reimbursement rates — and billed for procedures that were different from the ones actually performed. When insurance companies rejected the claims, he called, pretending to be an outraged patient or policyholder who was facing a huge bill and demanding that the insurer pay up.

One of the people he impersonated was NBA point guard Marcus Smart, who got hand surgery after hitting a picture frame in 2018, according to court papers filed by James’ lawyers.

Smart was then with the Boston Celtics, where he won the NBA defensive player of the year award in 2022 — the first guard so honored in more than a quarter-century. Smart now plays for the Memphis Grizzlies.

Smart testified at James’ trial that the impersonation upset him because he wasn’t raised to treat people the way James did, and that he was concerned it would damage his standing as a role model, according to prosecutors’ court papers.

Another victim was NFL lawyer and executive Jeff Pash, whose wife was treated for an injury she got while running in 2018. Jurors at James’ trial heard a recording of someone who purported to be Pash — but actually was James — hollering and swearing at a customer-service representative on an insurance provider’s dedicated line for NFL employees, Newsday reported at the time.

“These are people that work for the NFL, and I would hate to have them think that was me on that call,” Pash testified, saying he knew nothing about it until federal agents told him.

James’ lawyer, Paul Krieger, said in a court filing that James worked as a nurse before starting his own business in 2007. James developed a drinking problem in recent years as he came under stress from his work and family responsibilities, including caring for his parents, the lawyer wrote.

“He sincerely and deeply regrets his misguided phone calls and communications with insurance companies in which he pretended to be patients in an effort to maximize and expedite payments for the genuine medical services provided by his doctor-clients,” the attorney added, saying the calls were “an aberration” in the life of “a caring and decent person.”

United States News

Associated Press

A judge temporarily blocks Iowa law that allows authorities to charge people facing deportation

DES MOINES, Iowa (AP) — A federal judge on Monday temporarily blocked an Iowa law that allowed law enforcement in the state to file criminal charges against people with outstanding deportation orders or who previously had been denied entry to the U.S. U.S. District Court Judge Stephen Locher issued a preliminary injunction because he said […]

48 minutes ago

Associated Press

Wisconsin Supreme Court will hear a challenge to governor’s 400-year school funding veto

MADISON, Wis. (AP) — The Wisconsin Supreme Court will hear a challenge to Democratic Gov. Tony Evers’ partial veto that locked in a school funding increase for the next 400 years, the justices announced Monday. The Wisconsin Manufacturers & Commerce Litigation Center filed a lawsuit in April arguing the governor exceeded his authority. The group […]

2 hours ago

Associated Press

Retired AP reporter Hoyt Harwell dies at 93. He covered key events in the American South

HOOVER, Ala. (AP) — Hoyt Garland Harwell, a longtime reporter for The Associated Press who covered key events in the American South and was a mentor to young reporters, has died. He was 93. Harwell died at home June 12 following a brief illness, according to his obituary. Harwell worked for the AP for 42 […]

2 hours ago

Associated Press

Federal appellate panel sends Michigan pipeline challenge to state court

Michigan Attorney General Dana Nessel’s lawsuit seeking to shut down part of a petroleum pipeline that runs beneath the Straits of Mackinac belongs in state court, a federal appellate panel ruled Monday. The pipeline’s operator, Enbridge Inc., moved the case from state court to federal court more than two years past the deadline for changing […]

2 hours ago

Associated Press

Small plane with 1 aboard crashes into a Massachusetts river

LAWRENCE, Massachusetts (AP) — A small plane with one pilot aboard crashed into a Massachusetts river on Monday, according to authorities. It wasn’t immediately clear if the pilot survived the crash or was injured. The Federal Aviation Administration said the single-engine Van’s Aircraft RV-6A crashed into the Merrimack River in the town of Lawrence at […]

3 hours ago

Associated Press

No lie: Perfectly preserved centuries-old cherries unearthed at George Washington’s Mount Vernon

MOUNT VERNON, Va. (AP) — George Washington never did cut down the cherry tree, despite the famous story to the contrary, but he did pack away quite a few bottles of the fruit at his Mount Vernon home. Dozens of bottles of cherries and berries — impossibly preserved in storage pits uncovered from the cellar […]

3 hours ago

Sponsored Articles

...

COLLINS COMFORT MASTERS

Here are 5 things Arizona residents need to know about their HVAC system

It's warming back up in the Valley, which means it's time to think about your air conditioning system's preparedness for summer.

...

Midwestern University

Midwestern University Clinics: transforming health care in the valley

Midwestern University, long a fixture of comprehensive health care education in the West Valley, is also a recognized leader in community health care.

...

Collins Comfort Masters

Here’s 1 way to ensure your family is drinking safe water

Water is maybe one of the most important resources in our lives, and especially if you have kids, you want them to have access to safe water.

Man gets 12 years in prison in insurance scheme after posing as patients, including NBA player