PRESCOTT VALLEY - Attorney General Mark Brnovich announced today that Dr. Michael Lee Ham, Ophthalmologist and eye surgeon at Kokopelli Eye Institute, 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. Ham is accused of fraudulently billing the aforementioned institutions for hundreds of thousands of dollars for nearly a decade between 2009 and 2018. Ham was arrested on January 2 in Prescott Valley.
Kokopelli Eye Institute maintains eight ophthalmology offices in Arizona serving Prescott, Prescott Valley, Peoria, Wickenburg, Surprise, Kingman, Glendale, and Fountain Hills. 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.
All Defendants are presumed innocent until proven guilty in a court of law.
Assistant Attorneys General Cynthia Giltner and Brett Harames are prosecuting the case.
If you have information concerning these matters or this individual, please contact AZ AGO Special Agent Mark McClain, Special Investigation Section of the Health Care Fraud and Abuse Unit (Prescott office) at (928) 778-7463.
Dr. Michael Lee Ham (pictured below)