Ophthalmologist and eye surgeon, Dr. Michael Lee Ham, at Kokopelli Eye Institute, has been arrested in connection with defrauding the government agencies and insurers. Ham was indicted by a State Grand Jury for charges of Conspiracy, Fraudulent Schemes and Artifices, Illegal Control of an Enterprise, Theft, and Money Laundering.
Ham is accused of 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. Ham allegedly billed the victims for hundreds of thousands of dollars for nearly a decade between 2009 and 2018. Ham was arrested on January 2 in Prescott Valley.
According to the Arizona Attorney General’s Office, Kokopelli Eye Institute maintains eight ophthalmology offices in Arizona serving Prescott, Prescott Valley, Peoria, Wickenburg, Surprise, Kingman, Glendale, and Fountain Hills. Between May 13, 2009, and October 10, 2018, Dr. Ham allegedly 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 Arizona Attorney General’s Office alleges that 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.
Reportedly the 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, according to Arizona Attorney General’s Office.