Medical Biller Sentenced to 12 Years in Federal Prison After Patient Scheme Is Exposed

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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.

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