Rye eye doctor sentenced to 96 months in prison for prolific seven-year healthcare fraud scheme and Covid-19 loan fraud | USAO-SDNY

Damian Williams, the United States Attorney for the Southern District of New York, announced that AMEET GOYAL, MD (“GOYAL”), an ophthalmologist in Rye, New York, was sentenced today to 96 months in prison for orchestrating a seven-year health care fraud scheme by falsely charging millions of dollars for upcoded procedures, and also for fraudulently obtaining two government-backed loans intended to help small businesses during the COVID-19 pandemic. 19 while facing bail charges for the health care fraud scheme. Imposing the sentence today, U.S. District Judge Cathy Seibel noted, “The fraud doesn’t fully capture how egregious it was and how unwarranted it was… It wasn’t a matter of need was a matter of greed. GOYAL previously pleaded guilty to all charges in a six-count replacement indictment before Judge Seibel on September 13, 2021.

In addition to the jail sentence, GOYAL was today sentenced to five years of probation and ordered to pay $3.6 million forfeiture and $3.6 million restitution. GOYAL has already paid approximately $1.79 million for these bonds.

US Attorney Damian Williams said: “A prominent ophthalmologist and oculoplastic surgeon who has now given up his medical license, AMEET GOYAL was blinded by greed. Over a period of seven years, he took advantage of the trust placed in him and deceived patients and insurance companies out of $3.6 million in false accusations. To cover his tracks, he created fictitious operative reports, strewn across hundreds of patient records, violating the integrity of patients’ medical records and making it harder for subsequent physicians to assess their care. He sent patients who couldn’t pay the coded bills to a collection agency, decimating their credit. He pressured other doctors to join the program and threatened to take revenge on their livelihoods and careers. Even after being arrested for this scheme, GOYAL committed yet another jaw-dropping fraud and stole $637,200 from the Paycheck Protection Program at the start of a devastating pandemic. For his crimes, GOYAL will serve a heavy prison sentence.

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

At all material times, GOYAL owned and operated the ophthalmology practice Ameet Goyal MDPC, doing business as Rye Eye Associates, with offices in Rye, Mt. Kisco and Wappingers Falls, New York, and Greenwich, Connecticut ( office “). Between 2010 and 2017, GOYAL engaged in widespread healthcare fraud by systematically “coding” simpler, lower-paying surgical procedures and exams as complex, higher-paying major operations in bills. fraudulent claims 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 consent and, at times, no consent for the coded procedures he falsely claimed to have performed. As part of this scheme, GOYAL systematically falsified patients’ medical records, creating modeled fictitious operative reports that matched the complex operation he billed for rather than the various minor procedures he actually performed. GOYAL also pressured other employees in his firm to participate in the scheme and threatened the livelihoods of employees who refused to comply. GOYAL forced patients to pay thousands of dollars out of pocket for fraudulently billed charges and initiated debt collection proceedings against patients who failed to pay the full amount of these incidental charges. Due to his fraudulent billings, GOYAL was the most billed doctor in the tri-state area for several of his fraudulently billed codes, including one he billed seven times more frequently than all doctors in the tri-state area. United States. GOYAL was indicted on the health care fraud charges in November 2019 and was released on bail.

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

On or about April 2020, GOYAL applied to the SBA and Bank-1, a federally insured institution, for more than $630,000 in government-guaranteed loans through the PPP. Specifically, on or around April 21, 2020, GOYAL requested a loan in the amount of $358,700 for the business “Ameet Goyal”, with his own social security number and email address. On or about April 29, 2020, GOYAL applied for a second loan in the amount of $278,500, with a trade name “Rye eye associates”, using the employer identification number for Ameet Goyal, MDPC and a other email address controlled by GOYAL. However, to substantiate each loan, GOYAL submitted the exact same underlying payroll expense report, showing the same employees and the same payroll costs.

On both requests, GOYAL falsely replied that he had no pending criminal charges and electronically placed his initials “AG” directly below his “No” response. GOYAL also falsely certified, among other things, that his company would not receive another PPP loan until the end of the year. After gaining approval from Bank-1 and the SBA through his fraudulent misrepresentations, GOYAL executed loan memos 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 business checking account into which these funds were deposited to pay for business and personal expenses, including 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 winery and golf merchandise website.

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GOYAL, 58, of Rye, New York, pleaded guilty to six alternate counts. Count 1 charged health care fraud; the second count of wire fraud; and the third count charged with misrepresentation relating to health care matters. Counts four, five and six charge the accused, while on bail, with committing the following offences, respectively: bank fraud, misrepresentation in connection with a loan application and misrepresentation in a matter within the jurisdiction of the executive branch of the United States Government.

Mr. Williams commended the work of the Federal Bureau of Investigation, the US Department of Health and Human Services, the Office of Inspector General and the SBA Office of Inspector General.

This case is handled by the White Plains Division of the Bureau. Assistant U.S. Attorneys Vladislav Vainberg, David Felton and Margery Feinzig are charged with the prosecution. A civil fraud lawsuit related to health care fraud under the False Claims Act is being processed by the Bureau’s Civil Fraud Unit. Assistant U.S. Attorney Jeffrey K. Powell is in charge of the ongoing civil case.

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