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N.Y. eye doctor blew up simple surgeries, bogus-billed $8 million, DOJ charges

A downstate New York ophthalmologist stands accused of misrepresenting simple eyelid procedures as much more complicated surgeries and billing millions more than he should have for them.

Ameet Goyal M.D., P.C. proprietor of the Eye Associates Group in Rye, Mt. Kisco, and Wappingers Falls, has been indicted by the U.S. Attorney for the Southern District of New York on charges of wire fraud, health care fraud, and false claims, the U.S. Attorney for the Southern District of New York announced on Nov. 22.

Goyal stands accused of fraudulently billing Medicare, Medicaid, and private plans "at least approximately $8 million" and receiving $3 million. 

Chalazions are eyelid bumps similar to a stye, resulting from a clogged oil gland, excision of which is normally "performed under numbing anesthesia and... typically completed in less than 15 minutes."

Between January 2010 and March 2017, Goyal allegedly billed hundreds of his simple chalazion removals as eyelid excision and repair procedures, which typically pay about $500; as orbitotomies, which typically pay about $900; and conjunctivoplasties, which typically pay about $400. By comparison, a simple chalazion removal reimburses $200 on average, the U.S. Attorney states.

In these cases, the U.S. Attorney alleges, the more complex surgeries Goyal billed for "were not performed, and the procedure actually performed was an excision of chalazion or other similar lower-paying eyelid procedure."

The complaint also alleges that in addition to falsifying records himself, Goyal "threatened the livelihood of employees of the practice who were reluctant to comply with these directions" to support his fraud. 

Blog Tags: anti-fraud, compliance
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