- He falsely billed patients for millions of dollars of upcoded procedures, and fraudulently obtained two government-guaranteed loans intended to help small businesses during the COVID-19 pandemic while on bail.
Indian American ophthalmologist Ameet Goyal of Rye, New York, has been sentenced to 8 years in prison for orchestrating a seven-year healthcare fraud scheme. The Department of Justice said Goyal, 58, orchestrated “a seven-year healthcare fraud scheme by falsely billing for millions of dollars of upcoded procedures.” He also “fraudulently obtained two government-guaranteed loans intended to help small businesses during the COVID-19 pandemic while he was facing charges on pretrial release for the healthcare fraud scheme.”
In addition to the prison term, he was sentenced to five years of supervised release, and ordered to pay a forfeiture of $3.6 million and restitution of $3.6 million. He has “already paid approximately $1.79 million toward these obligations,” the DoJ said.
Goyal previously pled guilty to all charges in a six-count superseding indictment on Sept. 13, 2021. The first count charged healthcare fraud; the second count charged wire fraud, and the third count charged making false statements relating to health care matters. Counts four, five, and six charged that while on pretrial release, the defendant committed the following offenses, respectively: bank fraud, making false statements on a loan application, and making false statements in a matter within the jurisdiction of the executive branch of the U.S. government.
Goyal owned and operated the ophthalmology practice Ameet Goyal M.D. P.C., doing business as Rye Eye Associates, with offices in Rye, Mt. Kisco, and Wappingers Falls, New York, and Greenwich, Connecticut.
Between 2010 and 2017, he engaged in “widespread healthcare fraud by consistently ‘upcoding’ simpler, lower-paying surgical procedures and examinations as complex, higher-paying major operations in fraudulent billings submitted to Medicare, private insurance companies, and patients. “As a result, he fraudulently obtained at least $3.6 million in payments for procedures he did not perform,” the DoJ said.
As part of the scheme, he routinely falsified patient medical records, authoring fictitious templated operative reports that matched the complex operation he billed rather than the different minor procedures he actually performed. He also pressured other employees in his practice to engage in the scheme and threatened the livelihood of employees who refused to comply. He caused patients to pay thousands of dollars out of pocket for fraudulently billed charges, and initiated debt collection proceedings against patients who did not pay the full amounts of those false charges.
He was indicted for the healthcare fraud charges in November 2019 and was released on bail. While on bail, around April 2020, he applied to the SBA and Bank-1 for over $630,000 in government-guaranteed loans through the PPP. The first loan application was made in his name for $358,700, with his own social security number and email address. The second loan for $278,500, was made with a business name “Rye eye associates,” using the Employer Identification Number for Ameet Goyal, M.D. P.C and a different email address. To substantiate each loan, however, he submitted the exact same underlying payroll expense report, showing the same employees and payroll costs. On both applications, he falsely answered that he was not facing any pending criminal charges, and also certified falsely that his business would not receive another PPP loan until the end of the year.
After he received the loan amounts, “he used the business checking account into which these funds were deposited to pay business and personal expenses, including by making a payment to a country club in Westchester, New York within days of receiving the first loan, as well as payments to a California vineyard and golf merchandise website,” the DoJ said.