NYC Indian Ophthalmologist Dr. Ameet Goyal Arrested and Indicted for Healthcare Fraud

November 22, 2019 - NYC Indian Ophthalmologist Ameet Goyal (56) from Rye, NY is arrested and indicted today for fraudulently billing patients, Medicare, Medicaid and private insurance programs millions of dollars for complex eye surgeries that were never performed.

Besides a criminal complaint, a Civil Fraud Lawsuit was filed against Dr. Ameet Goyal and his medical practice The Eye Associates Group by the government under the False Claims Act.

The Eye Associates Group is owned and managed by Dr. Ameet Goyal with practices in Rye, Mt. Kisco, and Wappingers Falls, New York, and Greenwich, Connecticut.

Charges Against Dr. Ameet Goyal
NYC Indian doctor Ameet Goyal is charged with three counts:
According to the indictment against Dr. Ameet Goyal:
....From at least in or about January 2010 through in or about March 2017, GOYAL systematically submitted false and fraudulent claims that misrepresented the services provided to patients of the Practice and falsely billed for higher-paying surgical treatments than the lower-paying, minor procedures actually performed.

For example, GOYAL and others at the Practice routinely treated patients for an excision of a chalazion, a small bump on an eyelid, typically removed in less than 15 minutes. An excision of chalazion, when billed truthfully under its associated code, paid the Practice approximately $200 on average from patients and insurance programs. However, GOYAL systematically billed an excision of chalazion and other similar superficial eyelid procedures as if he had performed an orbitotomy together with a conjunctivoplasty, which are complex surgeries into the orbit of the eye, often to remove an orbital tumor, that typically take an hour or more to perform. These substantial surgeries, as billed, paid the Practice approximately $1,400 on average from a combination of insurance and patient out-of-pocket payments. Goyal also upcoded certain superficial procedures as an excision and repair of eyelid, a type of higher-paying eyelid surgery involving reconstruction or removal of certain lesions other than chalazions. During the relevant time period, GOYAL billed less than 40 chalazions under the billing code designated for excision of chalazion, while billing over 1,400 orbitotomies, over 700 bundled conjunctivoplasties, and over 1,600 excision and repair of eyelid surgeries, all of which he claimed to have performed personally.

To further effectuate the scheme, GOYAL directed other employees of the Practice, including other ophthalmologists, to upcode minor procedures into higher-paying surgeries. GOYAL threatened the livelihood of employees who were reluctant to comply with these directions.

Between about January 2010 through about March 2017, GOYAL caused the Practice to bill insurance programs and patients over $8 million for supposedly performed orbitotomies, bundled conjunctivoplasties, and excisions and repair of eyelid. The Practice received over $3 million in payments for these claims, a substantial portion of which were fraudulently billed.
According to the Civil Complaint, in addition to falsely billing for orbitotomies and conjunctivoplasties and other related codes:
GOYAL and his Practice routinely submitted fraudulent claims to Medicare and Medicaid for a wide range of other surgical procedures, examinations, and tests purportedly performed by GOYAL that were not actually performed, not medically necessary, not documented in the medical records, and/or failed to otherwise comply with Medicare and Medicaid rules and regulations. In order to justify this billing, GOYAL falsified patient diagnoses and prepared operative reports that falsely described the procedures performed on patients. The lawsuit seeks to recover treble damages and civil penalties under the False Claims Act.
Potential Penalty
On the first count of healthcare fraud, NYC Indian eye doctor Ameet Goyal faces a maximum sentence of 10 years in prison.

The second count of wire fraud against Dr. Ameet Goyal carries a maximum sentence of 20 years in prison.

And the third count of making false statements relating to health care matters against Dr. Ameet Goyal carries a maximum sentence of five years in prison.

The above mentioned maximum potential sentences are prescribed by Congress and are provided for informational purposes only and any sentencing of the defendant Dr. Ameet Goyal will be determined by the judge.

NYC Indian Ophthalmologist Dr. Ameet Goyal was arrested this morning and arraigned in federal court today.

Court Documents:
Civil Case Complaint Against Dr. Ameet Goyal & The Eye Associates Group
Dr. Ameet Goyal Indictment