乌鸦传媒

A New York ophthalmologist has deepened his problems with the feds after taking Paycheck Protection Program (PPP) loans that he wasn't eligible for because of previous criminal charges.

Ameet Goyal, MD, took more than $630,000 in two loans, when businesses are supposed to be limited to only one,

The previous healthcare fraud charges, , involved submitting false claims for surgeries Goyal didn't perform and for "upcoding" to more expensive procedures. From January 2010 to March 2017, Goyal billed more than $8 million for those procedures and received more than $3 million in payments, "a substantial portion of which were fraudulently billed," .

For the current charges in the , Goyal allegedly submitted two applications with different business names, email addresses, business identification numbers, and loan amounts for the same underlying practice. (Goyal's main practice is in Rye, New York, but he also has practices in Wappingers Falls and Mt. Kisco, New York and has a practice in Greenwich, Connecticut.)

According to the charges, on April 21, Goyal applied for a loan of $358,700 for his business "Ameet Goyal" doing business as "Eye associates" with his Rye practice address. On April 29, he applied for a second loan with the same Rye address totaling $278,500 under the name "Rye eye associates."

Goyal used identical payroll expense reports, which listed the same employees and payroll costs, to substantiate the two applications. On those applications, Goyal "falsely represented" that he "wasn't subject to any pending indictment," according to the DOJ.

"As alleged, Goyal blatantly lied on multiple loan applications that he was not subject to any indictment, and on top of that, fraudulently double-dipped into the limited assets of the Paycheck Protection Program by pretending to apply on behalf of two separate businesses," said Audrey Strauss, Acting U.S. Attorney for the southern district of New York.

In November 2019, Goyal was charged with healthcare fraud, wire fraud, and making false statements relating to healthcare matters. According to the DOJ, he fraudulently billed patients, Medicare and private insurers for orbitotomies, conjunctivoplasties in parallel to orbitotomies, and excisions and repairs of the eyelid that weren't performed.

Goyal rarely billed for treating chalazion, a common and minor eyelid condition in which a blocked oil gland causes a painless bump on the eyelid. It's often treated with warm compresses and gentle massage, though some require a surgical excision performed under local anesthesia in less than 15 minutes.

Goyal billed for chalazion excisions fewer than 40 times, according to the DOJ, typically at a rate of $400 and collecting $200.

However, he billed 1,600 times for excision and repair of the eyelid -- which typically involves reconstruction or removal of lesions other than a chalazion -- at a price of $1,500, receiving an average payment of $500.

Goyal also billed for the more complicated orbitotomy more than 1,400 times at $2,000 each, receiving $950 on average, even though this procedure is more frequently used to remove an orbital tumor.

On top of that, he billed for conjunctivoplasty on top of orbitotomy more than 700 times at a rate of $2,000 or $2,500 and received an additional $400 on top of each orbitotomy, the DOJ stated.

Goyal's practice systematically submitted claims "when in fact those surgeries were not performed and the procedure actually performed was an excision of chalazion or other similar lower-paying minor eyelid procedure," .

Comment