The U.S. Department of Justice (DOJ) announced on March 3 that Ameet Goyal, M.D., a Westchester-based ophthalmologist, was sentenced to 96 months in prison for falsely billing for millions of dollars of upcoded procedures over seven years, and for fraudulently obtaining two business loans under the CARES Act’s Paycheck Protection Program (PPP) in the early days of the COVID-19 pandemic. Goyal had previously pled guilty to all charges in September.

U.S. Attorney Damian Williams said, “Over a seven-year period, he preyed on the trust placed in him and cheated patients and insurance companies of $3.6 million in false charges. To cover his tracks, he created fictitious operative reports, seeded across hundreds of patient files, violating the integrity of patients’ medical records and making it more difficult for subsequent doctors to evaluate their care.” In imposing the sentence, U.S. District Judge Cathy Seibel said, “Fraud doesn’t fully capture how blatant this was and how unjustified this was.”

Goyal’s practice, Rye Eye Associates, had offices in Rye, Mount Kisco and Wappingers Falls, New York, and Greenwich, Connecticut. Between 2010 and 2017, Goyal fraudulently billed Medicare, private insurers and patients by consistently upcoding simple surgical procedures and examinations as more complex and expensive procedures, allowing him to obtain at least $3.6 million in reimbursements for procedures he did not perform. He also failed to obtain proper (or sometimes any) patient consents for the upcoded procedures; routinely falsified medical records to match the fraudulent billings; caused patients to pay out of pocket for the fraudulent charges; and sent patients who could not pay the upcoded bills to a collection agency, damaging their credit. Goyal was the highest-billing doctor in the tristate area for several of the fraudulently billed codes, one of which he billed seven times more often than all other doctors in the area combined.

Goyal’s PPP loan fraud included applying for two separate loans for his practice under different names, but using the same employee and payroll expense report to substantiate each loan. He was also ineligible for a PPP loan because of the pending criminal charges against him at the time, but falsely certified to the contrary on both applications. He used the loan proceeds to pay business and personal expenses, including payments to a Westchester country club, a California vineyard and a golf merchandise website.

In addition to the prison term, Goyal surrendered his medical license and was ordered to pay forfeiture of $3.6 million and restitution of $3.6 million. The investigation was a joint effort by the DOJ, FBI, Office of Inspector General of HHS, and Office of Inspector General of the U.S. Small Business Administration.

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