Indian American Physician From Chicago Admits Guilt In $2.4M Healthcare Fraud Case

An Indian American physician from the Chicago area has pleaded guilty to a federal healthcare fraud by billing Medicaid and private insurers for nonexistent services, according to the US Justice Department.

Mona Ghosh, 51, who owns and operates Progressive Women’s Healthcare, specialising in obstetrics and gynaecology services, pleaded guilty to two counts of health care fraud. Each count is punishable by up to ten years in federal prison. US District Judge Franklin U Valderrama has set sentencing for October 22.

Federal prosecutors allege that GhRosh is accountable for at least $2.4 million in fraudulently obtained reimbursements. She admitted in her plea agreement that she was accountable for more than $1.5 million of such fraudulently obtained reimbursements.

“MONA GHOSH owned and operated Progressive Women’s Healthcare, S.C., a medical office in Hoffman Estates, Ill., specializing in obstetrics and gynecology services.  From 2018 to 2022, Ghosh submitted and caused her employees to submit fraudulent claims to Medicaid, TRICARE, and numerous other insurers for procedures and services that were not provided or were not medically necessary, some of which were performed without patient consent,” the US Justice Department  said.

“Ghosh also fraudulently overstated the length and complexity of in-office and telemedicine visits and submitted claims using billing codes for which the visits did not qualify in order to seek higher reimbursement rates, her plea agreement states.  Ghosh admitted in the plea agreement that she prepared false patient medical records to support the fraudulent reimbursement claims,” the statement added.

The final amount will be determined by the court at sentencing, a media release said. According to court documents, from 2018 to 2022, Ghosh submitted, and caused her employees to submit, fraudulent claims to Medicaid, TRICARE, and numerous other insurers for procedures and services that were not provided or were not medically necessary, some of which were performed without patient consent.

Ghosh also fraudulently overstated the length and complexity of in-office and telemedicine visits and submitted claims using billing codes for which the visits did not qualify in order to seek higher reimbursement rates, her plea agreement states. She admitted that she had prepared false patient medical records to support the fraudulent reimbursement claims.