Suburban Chicago physician pleads guilty to Federal health care fraud charges

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A suburban Chicago physician of Indian origin has pleaded guilty to federal health care fraud charges for billing Medicaid and private insurers for nonexistent services.

Mona Ghosh, 51, of Inverness, Ill., pleaded guilty to two counts of health care fraud, a July 1, 2024, press release from the Justice Department said.  Each count is punishable by up to ten years in federal prison.

U.S. District Judge Franklin U. Valderrama set sentencing for Oct. 22, 2024.

According to the press release, Ghosh owned and operated Progressive Women’s Healthcare, S.C., a medical office in Hoffman Estates, Ill., specializing in obstetrics and gynecology services.

During the period from 2018 to 2022, Ghosh submitted and caused her employees to submit fraudulent claims to Medicaid, TRICARE, and numerous other insurers, according to DOJ. The claims were for procedures and services that were not provided or were not medically necessary, and some of which were performed without patient consent.

Ghosh also 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.

“It is the government’s position that Ghosh is accountable for at least $2.4 million in fraudulently obtained reimbursements,” the press release said.

Ghosh admitted in the plea agreement that she is accountable for more than $1.5 million of such fraudulently obtained reimbursements.  The final amount will be determined by the Court at sentencing.