Indian-American Physician Mona Ghosh: Mona Ghosh, a 51-year-old Indian-American physician working in suburban Chicago, Illinois, has pleaded guilty to federal healthcare fraud. She was accused of defrauding public and private insurance companies by billing them for services that did not exist. According to a report by news agency PTI, Mona Ghosh is the owner and operator of Progressive Women’s Healthcare, which specializes in obstetrics and gynecology services. She has pleaded guilty to two counts of healthcare fraud. Mona Ghosh could face up to ten years in federal prison on each count. US District Judge Franklin U Valderrama has set October 22 as the date for sentencing in the case.
How much amount of fraud is Mona Ghosh accused of?
Federal prosecutors allege that Mona Ghosh is responsible for the return of at least $2.4 million (more than Rs 20 crore today in Indian currency) obtained through fraud. At the same time, Mona Ghosh admitted in her plea that she is liable for more than $1.5 million (more than Rs 12.5 crore today) obtained through fraud. According to a press release issued by the US Attorney’s Office of the Northern District of Illinois on July 1, the final amount will be determined by the court at the time of sentencing.
How was the fraud carried out?
According to court documents, from 2018 to 2022, Ghosh submitted fraudulent claims to Medicaid (a public health insurance program that provides health care coverage to low-income families and individuals in the US), Tricare and several other insurance companies for procedures and services that were not provided or were not medically necessary, some of which were done without the consent of the patient.
Mona Ghosh’s plea agreement states that she fraudulently exaggerated the duration and complexity of office and telemedicine visits and submitted claims using billing codes for which the visits did not qualify in order to seek higher reimbursement rates. Mona Ghosh admitted that she prepared false patient medical records to support the fraudulent reimbursement claims.
