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Physician admits to $3.6M billing fraud, pocketing COVID-19 relief funds: 6 details

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A New York ophthalmologist pleaded guilty to collecting millions of dollars related to upcoding and fraudulently obtaining two government-guaranteed loans meant for COVID-19 pandemic relief, the U.S. Justice Department said this week.

Six details:

1. Ameet Goyal, MD, admitted to performing simple procedures, such as excision of chalazion, and billing for orbitotomy and conjunctivoplasty, which is more complex.

2. The excision of chalazion, or removing a bump from the eyelid, takes about 15 minutes and pays about $200 on average. Orbitotomy and conjunctivoplasty, which often involves removing orbital tumors and grafting to close the wound, takes about an hour and pays about $1,400 per procedure.

3. Dr. Goyal was indicted in the seven-year upcoding scheme in November 2019 and pleaded guilty Sept. 14. He fraudulently collected $3.6 million, and was required to forfeit the funds.

4. In April 2020, Dr. Goyal applied for and received two loans as part of the Coronavirus Aid, Relief, and Economic Security Act to assist businesses damaged by the COVID-19 pandemic. He applied for a $358,700 loan under his own name and a $278,500 loan under the name "Rye Eye Associates." He falsely stated on both applications that he wasn't under pending criminal charges, among other misrepresentations.

5. Dr. Goyal received the loans and used some of the funds for personal expenses, according to the Justice Department.

6. Sentencing is scheduled for January 2022, and Dr. Goyal faces multiple years in prison.

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