Ophthalmologist gets 8 years in prison for surgical billing scheme and COVID-19 fraud

Former ophthalmologist Ameet Goyal, owner of Rye (N.Y.) Eye Associates, was sentenced to 96 months in prison for a seven-year fraudulent healthcare billing scheme and for fraudulently obtaining two government-guaranteed small business loans, the Justice Department said March 3.

Mr. Goyal, who surrendered his medical license, was also sentenced to five years of supervised release and ordered to pay $7.2 million in forfeiture and restitution.

Between 2010 and 2017, Mr. Goyal regularly "upcoded" surgeries and examinations, documenting and billing them as more complex, higher-paying procedures, the Justice Department said. He amassed at least $3.6 million as a result of fraudulent billings he submitted to Medicare, private insurance companies and patients.

Patients were forced to pay thousands of dollars out of pocket for the fraudulently billed charges.

"He sent patients who could not pay the upcoded bills to a collection agency, decimating their credit," U.S. Attorney Damian Williams said, according to the Justice Department. "He pressured other doctors to join the scheme and threatened to retaliate against their livelihood and careers. Even after being arrested for this scheme, [Mr. Goyal] committed a breathtaking new fraud and stole $637,200 from the Paycheck Protection Program in the early days of a devastating pandemic."

As a result of his fraudulent billings, Mr. Goyal was the highest-billing physician in the tri-state area for several of his fraudulently billed codes, one of which he billed seven times more frequently than all physicians in the tri-state area combined, the Justice Department said.

He was indicted for the fraud charges in November 2019 and pled guilty to all charges on Sept. 13, 2021.

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