Indian American doctor gets 96 months jail for healthcare fraud

Rye, New York, ophthalmologist fraudulently obtained at least $3.6 million in payments for procedures he did not perform

Ameet Goyal, an Indian American ophthalmologist in Rye, New York, has been sentenced to 96 months in prison for orchestrating a seven-year healthcare fraud scheme and Covid-19 loan fraud.

Goyal, 58, allegedly billed 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 he was facing charges on pretrial release for the healthcare fraud scheme.

In imposing the sentence March 3, US District Judge Cathy Seibel noted, “Fraud doesn’t fully capture how blatant this was and how unjustified this was… This was not about need, it was about greed.”

Goyal previously pled guilty to all charges in a six-count superseding Indictment before Seibel on Sep 13, 2021, according to Damian Williams, the US attorney for the Southern District of New York.

In addition to the prison term, Goyal was sentenced to five years of supervised release, and ordered to pay forfeiture of $3.6 million and restitution of $3.6 million, a press release from Williams’ office said. Goyal has already paid approximately $1.79 million toward these obligations.

Read: Indian American charged with $5 million Covid-relief loan fraud (March 1, 2022)

“A prominent ophthalmologist and oculoplastic surgeon who has now surrendered his medical license, Ameet Goyal was blinded by greed,” 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,” he said.

Goyal allegedly sent patients who could not pay the upcoded bills to a collection agency, decimating their credit. He pressured other doctors to join the scheme and threatened to retaliate against their livelihood and careers.

“Even after being arrested for this scheme, Goyal committed a breathtaking new fraud and stole $637,200 from the Paycheck Protection Program in the early days of a devastating pandemic,” Williams said. “For his crimes, Goyal will serve a substantial sentence in prison.”

Between 2010 and 2017, doing business as Rye Eye Associates, with offices in Rye, Mt. Kisco, and Wappingers Falls, New York, and Greenwich, Connecticut, Goyal allegedly engaged in widespread healthcare fraud, according to court documents.

He did so 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, Goyal fraudulently obtained at least $3.6 million in payments for procedures he did not perform. Goyal failed to obtain proper and, at times, any consent for the upcoded procedures he falsely claimed to have performed, the release said.

As part of the scheme, Goyal routinely falsified patient medical records, authoring fictitious templated operative reports that matched the complex operation he billed rather than the different minor procedure he actually performed, according to court filings.

Goyal also pressured other employees in his practice to engage in the scheme, and threatened the livelihood of employees who refused to comply.

Goyal allegedly 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.

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

Goyal was indicted for the healthcare fraud charges in November 2019 and was released on bail.

In April 2020, Goyal applied to the SBA and Bank-1, a federally insured institution, for over $630,000 in Government-guaranteed loans through the SBA’s Paycheck Protection Program (“PPP”).

Specifically, on April 21, 2020, Goyal applied for a loan of $358,700 for the business “Ameet Goyal,” with his own social security number and e-mail address.

On April 29, 2020, Goyal applied for a second loan in the amount of $278,500, with a business name “Rye eye associates,” using the Employer Identification Number for Ameet Goyal and a different email address controlled by Goyal.

To substantiate each loan, however, Goyal submitted the exact same underlying payroll expense report, showing the same employees and payroll costs, according to court documents.

Read: Rye Ophthalmologist Sentenced To 96 Months In Prison For Prolific Seven-Year Healthcare Fraud Scheme And Covid-19 Loan Fraud (March 3, 2022)

On both applications, Goyal falsely answered that he was not facing any pending criminal charges, and electronically placed his initials “AG” directly under his “No” response. Goyal also falsely certified, among other things, that his business would not receive another PPP loan until the end of the year.

After obtaining approval from Bank-1 and the SBA through his fraudulent misrepresentations, 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 allegedly 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.