Eye Doctor Indicted For Fraud
Updated: Jan 15, 2020
An ophtalmologist and eye surgeon who operates Kokopelli Eye Institute centers in Kingman and seven other Arizona communities has been indicted by a State Grand Jury for charges of Conspiracy, Fraudulent Schemes and Artifices, Illegal Control of an Enterprise, Theft, and Money Laundering violations for allegedly defrauding Medicare, the United States Department of Veterans’ Affairs, and the Arizona Health Care Cost Containment System (AHCCCS), as well as several private health insurers. Attorney General Mark Brnovich has announced that Dr. Michael Lee Ham is accused of fraudulently billing for hundreds of thousands of dollars for nearly a decade between 2009 and 2018. Ham was arrested on January 2 in Prescott Valley.
It is alleged that between May 13, 2009, and October 10, 2018, Dr. Ham directed 46 current and former subordinate employees to fraudulently complete patient eye examination documents with false information and/or to artificially include deficient exam results in order to meet third-party insurer standards to determine whether disbursement of payments for cataract and laser surgeries are rendered.
The false information was calibrated in such fashion to satisfy the standards of third-party insurers, public and private, for cataract or laser surgery coverage. It is alleged fraudulent exam documents were maintained in patient records in the event of scrutiny or oversight via prospective audits related to the legitimacy or necessity of payments made to Kokopelli for cataract or laser surgery. It is possible that some patients had cataract surgeries that were not medically necessary.
The indictment follows a multi-agency investigation conducted by the Special Investigations Section of the Arizona Attorney General’s Office, the U.S. Department of Health and Human Services, Office of Inspector General, and AHCCCS.
This criminal case is ongoing. No further comments will be made regarding other Defendants.
Anyone with information concerning these matters or this individual are asked to contact AZ AGO Special Agent Mark McClain, Special Investigation Section of the Health Care Fraud and Abuse Unit (Prescott office) at (928) 778-7463.