Officials say the eye doctor who had practices in the Hudson Valley, New York State and Connecticut was "blinded by greed."

Ameet Goyal, an ophthalmologist in New York, was sentenced to 96 months in prison for orchestrating a seven-year healthcare fraud scheme by falsely billing for millions of dollars of upcoded procedures, and also for fraudulently obtaining 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.

“Fraud doesn’t fully capture how blatant this was and how unjustified this was. This was not about need, it was about greed," U.S. District Judge Cathy Seibel noted while imposing the sentence.

Goyal, an eye doctor with practices in Wappinger Falls, Rye, Mt. Kisco and Connecticut, previously pleaded guilty to all charges in a six-count superseding indictment on September 13, 2021.

Ameet G/Linkedin
Ameet G/Linkedin

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

According to the indictment, Goyal, 58, of Rye, fraudulently billed patients, Medicare and private insurance programs millions of dollars, between 2010 and 2017, for complex eye surgeries that Goyal never performed. The civil complaint further alleges that the doctor and his medical practice engaged in widespread healthcare fraud by consistently “upcoding” these and other surgical procedures, examinations, and tests in fraudulent billings submitted to Medicare and Medicaid.

"He 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," Williams added.

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Getty Images/iStockphoto

Between about January 2010 through about March 2017, Goyal caused his practice to bill insurance programs and patients for supposedly performed orbitotomies, bundled conjunctivoplasties and excisions and repair of the eyelid, officials say. The practice received over $3 million in payments for these claims, a substantial portion of which were fraudulently billed, according to the indictment.

Ophthalmologist with female patient

Goyal also allegedly 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.

"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," Williams said.

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

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