Indian-American physician pleads guilty to healthcare fraud, faces 20-year jail

A 51-year-old Indian-American physician from Chicago has pleaded guilty to two counts of federal healthcare fraud charges for billing Medicaid and private insurers for nonexistent services. She faces 20 years in prison.

According to the US Attorney’s office, Mona Ghosh owned and operated Progressive Women’s Healthcare, which specialises in obstetrics and gynaecology services.

She admitted that she and her employees submitted reimbursement claims to Medicaid, TRICARE and numerous other 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 to falsifying medical records to support the fake reimbursement claims to the insurance companies, it added.

The Indian-American physician, who belongs to Inverness in Illinois, pleaded guilty on June 27 (Thursday) to two counts of healthcare fraud, with each count warranting a punishable offence and carrying a jail term of 10 years. Her sentencing is 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. A US court will determine the final amount at the sentencing.

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, CBS News reported.

Ghosh was charged with 13 counts of healthcare fraud, with each count carrying a 10-year jail term.