Chicago: Mona Ghosh, a 51-year-old Indian American OB-GYN, admitted to submitting reimbursement claims to insurers for services and procedures that were not provided or medically necessary, according to the US Justice Department.
The Chicago doctor, has pleaded guilty to federal healthcare fraud charges, and faces 20 years in prison for billing Medicaid and private insurers for nonexistent services.
According to the US Attorney’s office, Mona Ghosh owned and operated Progressive Women’s Healthcare, which specialises in obstetrics and gynaecology services.
As per the documents, she and her employees admitted to submitting reimbursement claims to various insurers for services and procedures that were either not provided or not medically necessary.
Ghosh “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 to seek higher reimbursement rates,” the US Attorney’s Office said.
She also admitted falsifying medical records to support the fake reimbursement claims to the insurance companies, it added.
Another physician from Inverness, Illinois, also pleaded guilty to two counts of healthcare fraud on June 27, each requiring a 10-year prison sentence, with her sentencing expected on October 22.
According to the US Attorney’s Office, Ghosh is accountable for at least USD 2.4 million (around Rs 20.03 crore) in fraudulently obtained reimbursements. The final amount will be determined by the court at sentencing, a media release said.
Ghosh submitted fraudulent claims to Medicaid, TRICARE, and other insurers between 2018 and 2022, for unnecessary procedures and services, some performed without patient consent, as per court documents.
In March last year, Ghosh was indicted by a federal grand jury on charges of healthcare fraud. According to the indictment, the physician and her clinic obtained USD 796,000 (around Rs 6.64 crore) through fraudulent means, media reports said.
Ghosh was charged with 13 counts of healthcare fraud, with each count carrying a 10-year jail term. She admitted to preparing false patient medical records to support fraudulent reimbursement claims, the statement said.
