A federal jury has convicted a New York man today in a more than $ 600 million health care scheme, wired fraud, and an identity theft scheme.
According to court documents and evidence presented at trial, Mathew James, 54, of East Northport, operated a medical accounting firm that took into account proceedings that were either more serious or completely different from those performed by those. the doctor-clients of James. James ordered his doctor-clients to schedule elective surgeries through the emergency room so that insurance companies would reimburse at substantially higher rates. When insurance companies denied the inflated claims, James impersonated patients to demand that insurance companies pay the outstanding balances of tens or hundreds of thousands of dollars.
“James orchestrated a fraudulent medical billing scheme to steal from insurance companies and businesses, in order to afford his own pockets,” said Assistant Attorney General Kenneth A. Polite, Jr. of the Criminal Division of the Department of Justice. “This conviction shows that those who pay the medical bills that provoke healthcare fraud will be brought to justice.”
“The accused is guilty of carrying out a daring scheme in which he used insurance companies such as ATM machines. He stole hundreds of millions of dollars until he was finally exposed by a mile-long paper trail, phone recordings in which he imprisoned patients, and messages and emails with his co-conspiracy doctor clients showing bad practices. of his accounts. For this massive fraud, a federal jury convicted him today, “said U.S. Attorney Breon Peace for the Eastern District of New York. “Healthcare fraud is not a victimless crime, because fraudulent bills ultimately affect consumers who want to pay the cost of higher insurance premiums.”
“Healthcare fraud, including such fraudulent billing schemes, costs U.S. taxpayers tens of billions of dollars a year. “These offenses impact us all in many ways, including increased health insurance premiums, out-of-pocket costs and co-payment amounts for medical treatment, and reduced or lost benefits, to name a few.” said Assistant Director Luis Quesada of the FBI’s Criminal Investigation Division. “The FBI, along with our law enforcement partners, is committed to eradicating healthcare fraud in all its forms and bringing those seeking to exploit the healthcare system to justice. our strength in the face of justice. “
James was convicted of conspiracy to commit health care fraud, health care fraud, three counts of wire fraud, and three counts of aggravated identity theft. He is scheduled to be sentenced at a later date and faces up to 10 years in prison for conspiracy to commit fraud in healthcare, up to 10 years in prison for fraud in healthcare, up to 20 years in prison for each of the three counts of wire fraud, and a mandatory minimum of two years each for three counts of aggravated identity theft. A federal district court judge will determine any sentence after considering U.S. Sentencing Guidelines and other statutory factors.
Acting Assistant Chief Miriam Glaser Dauermann of the Fraud Division of the U.S. Criminal Division and Assistant Attorneys Catherine Mirabile and Antoinette Rangel of the Eastern District of New York are leading the prosecution of the case.
The Fraud Section leads the efforts of the Criminal Division to fight healthcare fraud through the Health Care Fraud Force Program. As of March 2007, this program, comprised of 15 strike forces operating in 24 federal districts, has charged more than 4,200 defendants who have collectively accounted for more than $ 19 billion in the Medicare program. In addition, the Centers for Medicare & amp; Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, is taking steps to hold providers accountable for their involvement in healthcare fraud schemes. health. More information can be found at https://www.justice.gov/criminal-fraud/health-care-fraud-unit.
What happens when someone wires you money?
Wired transfer facilitates electronic money transfers over a network of banks or transfer agencies around the world. The senders pay for the transaction at the sending bank and provide the name of the recipient, the bank account number, and the amount transferred.
Can you be scammed on a wire transfer? Typically, the scammer charges a fee through a mobile payment app or wire transfer because they are usually irreversible. Read also : An anonymous donation of $30,000 will benefit the Clay County Youth Food Delivery Program. If you pass the money to the scammer, you will never receive the product and you are unlikely to get your money back.
Is it safe to wire money to someone?
Are wire transfers safe? Compared to placing a check by mail, wire transfers are considered an extremely secure way to transfer money. They are secure transactions initiated by authorized personnel in your bank or non-bank wire transfer service. Once initiated, they cannot be canceled.
Is wiring money reversible?
Your wire transfer may be reversible if the bank that initiated the transfer made a mistake. Read also : What are the mineral rights in real estate?. For example, if the recipient received more money than he should have, that issue could be resolved.
Do banks Flag wire transfers?
Financial institutions and money transfer providers are required to report international transfers in excess of $ 10,000. You can learn more about the Bank Secrecy Act from the Currency Controller’s Office. Read also : How To Save Money When Traveling This Summer. Generally, they do not report transactions valued below that threshold.
Do banks report wire transfers? Banks must report all wire transfers over $ 10,000 using a Currency Transaction Report (CTR) and submit it to the Financial Crime Enforcement Network (FinCEN).
Do banks Flag large wire transfers?
By law, banks report all cash transactions in excess of $ 10,000 – the international money transfer reporting limit set by the IRS. In addition, a bank may report any transaction of any amount that warns of its suspicions.
Can a wire transfer be flagged?
Wired transfers can be marked for various reasons, notifying officials of the possibility of misconduct by either the recipient or the sender in the case of: Transfers to countries of refuge. Transfers to non – account holders. Regular transfers for no viable reason.
How long does a wire fraud investigation take?
Typically bank fraud investigations take up to 45 days.
What happens when your bank account is under investigation? If your bank account is under investigation, the bank will typically notify you. You can receive an informal notification via email, but generally, you also receive a formal notification by mail. This is especially true if the bank needs to freeze your account.
How long do bank fraud investigations take?
If fraud is reported or an ‘unauthorized’ dispute is lodged, a period of 10 days begins within which the bank must terminate its investigation. The bank may request an extension, but if the investigation takes more than 10 days to complete, they will typically issue a provisional refund to the cardholder.
How does bank investigate wire fraud?
According to that document, banks should follow an investigation checklist for each reported incident that includes actions such as: Determining when and how the fraud occurred. In this case, the bank may be looking for information and documents showing that someone was provided with fraudulent wire instructions.
