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Westchester resident Ameet Goyal, age 58, of Rye, who operated The Eye Associates Group, with practices in Rye, Mount Kisco, Wappingers Falls in Dutchess County, and Greenwich, has been sentenced to 96 months in prison for orchestrating a seven-year fraud scheme and for obtaining government loans intended for small businesses during the pandemic.
In addition to the prison term, Goyal was sentenced to five years of supervised release, ordered to forfeit $3.6 million and to pay $3.6 million in restitution. US Attorney Damian Williams noted that Goyal has already paid approximately $1.79 million of his court-ordered obligations.
While imposing his sentence, US District Judge Cathy Seibel took Goyal to task, saying that "Fraud doesn’t fully capture how blatant this was and how unjustified this was… This was not about need, it was about greed."
Between 2010 and 2017, Goyal was billing patients, Medicare, and private insurance programs millions of dollars for complex eye surgeries that were never actually performed, prosecutors said, noting that Goyal and his associates also allegedly “upcoded” those and other surgeries.
According to court documents:
Goyal falsified patient medical records, pressured other employees in his practice to engage in the scheme, and initiated debt collection proceedings against patients who did not pay the full amounts of his fraudulently billed charges.
As part of his scheme, Goyal also pressured other employees in his practice to engage in the same scheme, threatening the livelihood of employees who failed to comply with the fraud.
Williams said that Goyal 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.
He was arrested for healthcare fraud in 2019 and released on bail.
While out on bail, in April 2020, Goyal fraudulently obtained government-guaranteed loans intended to help small businesses during the COVID-19 pandemic while he was out on pretrial release.
Due to his pending criminal charges, Goyal's ophthalmology practice was not eligible for the government's Paycheck Protection Program (PPP), which was designed to offer financial relief to small businesses during the pandemic.
In April, to gain access to PPP funding, Goyal falsely represented on two separate applications to the US Small Business Administration and a Manhattan bank that he was not subject to any pending indictment.
Goyal also circumvented a condition of the PPP by applying for two loans with different business names, email addresses, business identification numbers, and loan amounts.
As part of the scheme, Goyal obtained two PPP loans for more than $630,000.
"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."
Goyal pleaded guilty in September 2021 to:
- Healthcare fraud;
- Wire fraud;
- Making false statements relating to healthcare matters;
- Bank fraud;
- Making false statements on a loan application;
- Making false statements in a matter within the jurisdiction of the executive branch of the government of the United States.
"(Goyal) sent patients who could not pay the upcoded bills to a collection agency, decimating their credit," Williams continued. "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. For his crimes, Goyal will serve a substantial sentence in prison."
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