Ophthalmologist Pleads Guilty to Seven-Year Healthcare Fraud Program and SBA Fraud Program to Help Small Businesses During COVID-19 Pandemic | USAO-SDNY

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Audrey Strauss, the United States Attorney for the Southern District of New York, announced that AMEET GOYAL, an ophthalmologist from Rye, New York, pleaded guilty yesterday to carrying out a healthcare fraud scheme falsely billing millions of dollars for procedures it didn’t work, and also fraudulently obtaining two government-guaranteed loans meant to help small businesses during the COVID-19 pandemic while coping with bail charges for the healthcare fraud program. GOYAL pleaded guilty before U.S. District Judge Cathy Seibel to all counts in an indictment replacing six counts.

American lawyer Audrey Strauss said: “Dr. Ameet Goyal was an experienced ophthalmologist who became blinded by greed and systematically defrauded patients who trusted him to cure their eyes. He vastly overcharged minor ophthalmic procedures, billed for tests and procedures that were never performed, falsified medical records, attempted to bribe others in his practice to encourage the program, and referred patients who refused to pay its fraudulent fees to collections. Already accused of defrauding patients and insurers of millions of dollars, Goyal has committed yet another fraud by soliciting paycheck protection program loans on behalf of two separate companies and lying on the claims. Goyal looted more than $ 630,000 in federal funds earmarked for legitimate small businesses affected by the COVID-19 pandemic. Goyal has now admitted to the two fraudulent schemes, agreed to lose $ 3.6 million and faces the possibility of a significant jail term. “

According to the allegations contained in the indictment, court documents and statements made during the court proceedings:

At all material times, GOYAL owned and operated the Ameet Goyal MDPC ophthalmology practice, doing business as Rye Eye Associates, with offices in Rye, Mt. Kisco, and Wappingers Falls, New York, and Greenwich, Connecticut ( the “Practice”). Between 2010 and 2017, GOYAL engaged in widespread healthcare fraud by systematically upcoding simpler and less remunerative surgical procedures and examinations as major complex and higher paying operations in the context of fraudulent billings submitted to Medicare, private insurance companies and patients. As a result, GOYAL fraudulently obtained at least $ 3.6 million in payments for procedures it did not perform. As part of this program, GOYAL systematically falsified patient medical records, creating modeled fictitious operative reports that matched the complex operation he billed rather than the different minor procedure he actually performed. . GOYAL also pressured other cabinet employees to join the program and threatened the livelihoods of employees who refused to comply. GOYAL forced patients to pay thousands of dollars out of pocket for fraudulently billed fees and initiated debt collection proceedings against patients who failed to pay all of these incidentals.

For example, GOYAL and others in the practice regularly treated patients for excision of a chalazion, a small lump on an eyelid, usually removed in less than 15 minutes. A chalazion excision, when billed honestly under its associated code, paid the office about $ 200 on average from patients and insurance programs. However, GOYAL routinely billed a chalazion excision and other similar superficial eyelid procedures as if he performed an orbitotomy with conjunctivoplasty, which are complex surgeries in the eye socket, often to remove an orbit. orbital tumor with a graft to close the resulting injury, which usually take an hour or more to complete. These major surgeries, as billed, paid the office about $ 1,400 on average from a combination of insurance and out-of-pocket payments. GOYAL has also coded certain superficial procedures such as eyelid excision and repair, a higher-paying type of eyelid surgery involving the reconstruction or removal of certain lesions other than chalazia. During the Relevant Period, GOYAL billed less than 40 chalazions under the designated billing code for chalazion excision, while billing for over 1,400 orbitotomies, over 700 pooled conjunctivoplasties and over 1,600 excisions and repairs of eyelid surgeries, which he claimed to have personally performed. The scheme involved numerous other CPT codes for procedures and exams not performed or not coded, resulting in at least $ 3.6 million in ill-gotten gains for GOYAL.

On November 21, 2019, an indictment (the “Indictment”) was issued in connection with the action United States of America v. Ameet Goyal, 19 Cr. 844 (CS) (SDNY), accusing GOYAL of healthcare fraud, wire fraud and misrepresentation regarding health matters. On November 22, 2019, GOYAL was arrested on the indictment and released on bail under an order informing GOYAL of the potential effect of committing a criminal offense while on bail.

The Coronavirus Aid, Relief, and Economic Security (“CARES”) Act is a federal law enacted on March 29, 2020, designed to provide emergency financial assistance to the millions of Americans suffering the economic effects caused by the COVID pandemic. -19. . One of the sources of relief under the CARES Act was the authorization of hundreds of billions of dollars in forgivable loans to small businesses for job retention and certain other expenses through the Check Protection Program. Small Business Administration (“SBA”) Payroll (“PPP”). Applicants with pending criminal charges are not eligible for PPP loans. PPP also limits each eligible borrower to a single loan and a maximum loan amount calculated based on a company’s average monthly salary expenses.

Around April 2020, GOYAL requested from the SBA and Bank-1, a federally insured institution, more than $ 630,000 in government guaranteed loans under the SBA’s PPP program. More specifically, on or around April 21, 2020, GOYAL requested a loan in the amount of $ 358,700 for the company “Ameet Goyal”, with its own social security number and email address. On or around April 29, 2020, GOYAL applied for a second loan in the amount of $ 278,500, with the business name “Rye eye Associates”, using the Employer ID number for Ameet Goyal MDPC and a different email address controlled by GOYAL. However, to justify each loan, GOYAL submitted the exact same underlying salary expense report, showing the same employees and the same salary costs.

In both requests, GOYAL falsely replied that he was not the subject of any pending criminal charges and electronically placed his initials “AG” directly below his “No” answer. GOYAL also falsely certified, among other things, that his company would not receive another PPP loan until the end of the year. After gaining Bank-1 and SBA approval through his fraudulent misrepresentation, GOYAL executed loan notes for two loans. On May 4, 2020, GOYAL received the first loan of $ 358,700 and on May 11, 2021, GOYAL received the second loan of $ 278,500. GOYAL used the corporate checking account in which these funds were deposited to pay for business and personal expenses, including making a payment of $ 1,800 to a country club in Westchester, New York, within days of receiving the first loan.

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GOYAL, 58, of Rye, New York, pleaded guilty to all six counts in the indictment. The first count charged with healthcare fraud, carrying a maximum sentence of 10 years in prison; the second count of wire fraud, punishable by up to 20 years in prison; and the third count of misrepresentation relating to health care matters, punishable by up to five years in prison. Charges four, five and six charged the defendant with committing the following offenses, respectively, while on bail: bank fraud, punishable by up to 30 years in prison; making false statements on a loan application, punishable by up to 30 years in prison; and making false statements in a matter under the jurisdiction of the executive branch of the United States government, punishable by up to five years in prison. In addition, a conviction on counts four, five and six, if committed during provisional release, carries an additional maximum sentence of 10 years in prison following any other prison sentence.

The potential maximum sentences are prescribed by Congress and are provided here for informational purposes only, as any conviction of the defendant will be determined by the judge.

GOYAL must be sentenced by Judge Seibel on January 6, 2022, at 2:30 p.m.

Ms. Strauss praised the work of the Federal Bureau of Investigation, the US Department of Health and Human Services, the Office of the Inspector General and the Office of the Inspector General of the SBA, whose expertise and diligence have is an integral part of the development of this survey. and guilty plea.

This case is being handled by the White Plains division of the Bureau. Deputy US prosecutors Vladislav Vainberg, David Felton and Margery Feinzig are in charge of the prosecution. A civil fraud lawsuit related to healthcare fraud under the False Claims Act is handled by the Civil Fraud Unit of the Bureau. Assistant US Attorney Jeffrey K. Powell is in charge of the pending civil case.


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