NFL executive testifies at fraud trial of biller who impersonated him, feds say
Mathew James, left, leaves the Central Islip federal courthouse on Thursday. Credit: John Roca
A National Football League executive testified Thursday at the federal fraud trial of a St. James medical biller who prosecutors say impersonated him in phone calls to his health care insurance company as part of a multimillion dollar scheme.
Jeff Pash, the NFL’s general counsel and executive vice president, took the stand for the prosecution in federal court in Central Islip at the trial of Matthew James, 54, a third-party medical biller. James is charged with health care and wire fraud, conspiracy to commit health care fraud and other charges for allegedly engaging in a massive scheme to defraud insurance companies through fraudulent billing practices.
Pash, 65, of Manhattan, whose full name is Lyle Jeffrey Pash, testified that his wife Betsy Pash cut open her chin on April 2, 2018 while running in Palm Beach, Florida. On the recommendation of a friend, she visited a plastic surgeon at Lenox Hill Hospital and returned home that same day, he said. Pash never received a bill from the hospital visit, which included the doctor giving his wife stitches, Pash said.
But a man who identified himself as Pash — who prosecutors allege was James — called the NFL’s customer service line at its health care insurance provider CIGNA, and claimed to have been billed $35,628.30 and demanded the insurer cover the invoice, according to a recording of multiple calls, which prosecutors played in court Thursday. At times, the caller claiming to be Pash swore and yelled at a customer service representative.
Asked by Assistant U.S. Attorney Catherine Mirable for his response to the calls, Pash said he had not made the calls and had “no idea” of the alleged fraud until federal agents came to his office and played one of the calls.
“These are people that work for the NFL and I would hate to have them think that was me on that call,” said Pash, adding that he was surprised no one from the organization had called to say “hey, who’s this jerk?”
Pash is just one of scores of people who federal prosecutors allege James impersonated in thousands of fraudulent calls. Prosecutors said James netted $63 million in the scheme by taking 10 or 15 percent from the fraudulent claims that were paid.
James used the ill-gotten gains, according to prosecutors, to buy and renovate properties on Long Island, as well as to purchase a red Ferrari and lease multiple Porches.
James’ attorneys declined to comment as they left court with their client Thursday afternoon. In the trial’s opening statements, James’ attorney Paul Krieger said he was “far from a perfect biller,” conceding he was “aggressive” with his billing and coding.
“He pushed the boundaries with insurance companies,” said Krieger, adding: “Matt tried to get the insurance companies to pay the doctors who hired Matt as much as these physicians’ billed charges as possible. But none of that is a crime, none of that is fraud, none of that is aggravated identify theft, none of that is money laundering.”
Prosecutors allege James also forged signatures of patients, submitted paperwork without their knowledge or consent and fraudulently billed for procedures that were different from what was actually performed or that never took place. And, according to Assistant U.S. Attorney Antoinette Rangel, James, working with “corrupt doctors” staged fake emergency room visits to bill “as much as possible.”
Nicole Fuller is Newsday's senior criminal justice reporter. She began working at Newsday in 2012 and previously covered local government.