Indian-American doctor found guilty of ₹20 cr healthcare billing fraud
Updated: Jul 3rd, 2024
A 51-year-old Indian-origin doctor Mona Ghosh has pleaded guilty to federal healthcare fraud charges for billing Medicaid and private insurers for services that were not provided.
Chicago-based Doctor Ghosh has been charged with defrauding Medicaid and private insurance companies through non-existent assistant services. She owned Progressive Women’s HealthCare, specialising in women’s health services.
Ghosh pleaded guilty to two counts of healthcare fraud. Each count is punishable by up to 10 years in federal prison. US District Judge Franklin U Valderrama set sentencing for Oct 22, 2024.
She is accountable for at least $2.4 million (₹20 crore) in fraudulently obtained reimbursements. She also admitted in the plea agreement that she is accountable for more than $1.5 million (₹1.25 crore) of such fraudulently obtained reimbursements. The final amount will be determined by the court at sentencing.
According to the release from court, between 2018 and 2022, Ghosh had pleaded guilty to orchestrating a scheme where she and her employees submitted false claims to Medicaid, TRICARE, and several other insurance providers.
These claims included billing for procedures and services that were either never performed or deemed unnecessary, some of which were carried out without patient consent. Ghosh also confessed to inflating the complexity and duration of both in-office and telemedicine appointments to higher reimbursement rates, using billing codes that did not accurately reflect the services provided. As part of her plea agreement, Ghosh admitted to falsifying patient medical records to substantiate these fraudulent claims.
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