Harrison eye surgeon Ameet Goyal pleaded guilty to health care and bank frauds on Sept. 13, a week before his trial was to begin in federal court, White Plains.
Goyal admitted he overbilled Medicare, private insurance plans and patients by $3.6 million from 2010 to 2017 and pocketing $637,200 in Covid-19 relief loans he was ineligible to receive.
He “decided to plead guilty,” according to a plea deal, “because he is in fact guilty.”
Goyal, 58, owned and operated Dutchess Eye Associates, Eye Associates Group, Greenwich Eye Associates, Mt. Kisco Eye Associates and Rye Eye Associates.
The health care scheme was based on upcoding simple eye surgeries to more lucrative and complex surgeries, according to court records.
For instance, he routinely excised small bumps on patients’ eyelids, in a procedure that typically took 15 minutes and paid $200. But he billed health care insurers and patients for removal of orbital tumors and grafting, procedures that take an hour or more to perform and pay $1,400.
The actual procedure was billed correctly about 40 times, according to the government. Complex procedures that were not done were billed about 3,700 times.
Goyal submitted claims for $8 million, according to court records, and received more than $3 million. He also charged patients for work that was not done and initiated debt collection actions against patients who did not pay up.
The government says Goyal pressured employees to falsify bills and medical records and threatened the livelihoods of those who refused to comply.
Three doctors had agreed to testify at the trial for the government “about their observations and experiences” working for Goyal, according to a Sept. 3 letter from prosecutors to U.S. District Judge Cathy Seibel.
When Goyal was released from custody after his November 2019 indictment, he was warned not to commit any more crimes. Five months later, according to a superseding indictment, he applied for two Paycheck Protection Program loans totaling $637,200.
The Coronavirus Aid, Relief, and Economic Security Act allows only one PPP loan per borrower and no loans for applicants with pending criminal charges.
Goyal used some of the loan money for personal expenses, including an $1,800 payment to a country club.
The superseding indictment charged him with two bank fraud charges and making false statements while on pretrial release.
When Goyal was released on bail last year, Seibel placed him on home incarceration with electronic monitoring and with limited and monitored internet access. She ordered him to close his medical practices, withdraw from health insurance programs and surrender his medical license.
The plea agreement recommends imprisonment of 151 to 188 months.
The former doctor also agreed to forfeit $3.6 million and pay a fine up to $350,000. The bank that was defrauded in the PPP loan scheme has recovered $637,200 from Goyal.
The plea deal does not explicitly say whether Goyal is a U.S. citizen, but he acknowledged the possible immigration consequences of pleading guilty, including denaturalization or removal in a separate proceeding.
Sentencing by Seibel is scheduled for Jan. 6.
