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Owensboro man pleads responsible to medical insurance fraud – jj

Owensboro man pleads responsible to medical insurance fraud


An Owensboro man pleaded guilty to conspiracy to commit health insurance fraud Monday in Lexington and could face up to five years in prison.

Dinesh Goyal, 60, pleaded guilty Monday in U.S. District Court. According to the U.S. Attorney’s office in the Eastern District of Kentucky, Goyal owned Tristate Medical Laboratory in Owensboro, while his co-conspirators, Mason Routt and Sam Ford, owned C.A.L. Laboratory Services in Nicholasville. C.A.L. performed drug testing.

A press release from the U.S. Attorney’s office says state Medicaid officials became concerned some of C.A.L.’s claims for Medicaid reimbursement were illegitimate and placed payment restrictions on the company. The release says Goyal, Routt and Ford then devised a plan that C.A.L.’s billing for urine testing would be sent through Tristate Medical as if the tests had been performed by Tristate.

“In this way, C.A.L. evaded the payment restrictions placed upon it by the insurers, and received reimbursements for which it was not entitled,” the press release says. The release says Goyal received a cut of 40 percent of the reimbursements.

The release says the scheme caused Humana CareSource, Aetna Coventry Cares and Anthem Blue Cross & Blue Shield to lose $1.378 million.

Goyal will be sentenced on Oct. 15.

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