Suburban Chicago Physician Sentenced to Ten Years in Federal Prison for Health Care Fraud
A suburban Chicago physician has been sentenced to ten years in federal prison for billing Medicaid and private insurers for nonexistent and unnecessary services.
Mona Ghosh owned and operated Progressive Women’s Healthcare, S.C., a medical office in Hoffman Estates, Ill., specializing in obstetrics and gynecology services.
From 2018 to 2022, Ghosh submitted and caused her employees to submit fraudulent claims to Medicaid, TRICARE, and numerous other insurers for procedures and services that were not medically necessary, including endometrial ablations and biopsies, ultrasounds, vaccinations, laboratory blood tests, and tests for sexually transmitted diseases.
Some of the procedures were performed without patient consent. Ghosh also 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 in order to seek higher reimbursement rates.
Ghosh prepared false patient medical records to support the fraudulent reimbursement claims.
Ghosh, 52, of Inverness, Ill., pleaded guilty last year to two counts of health care fraud. On Monday, U.S. District Judge Franklin U. Valderrama imposed the ten-year prison sentence and ordered Ghosh to pay approximately $1.5 million in restitution.
The sentence was announced by Andrew S. Boutros, United States Attorney for the Northern District of Illinois; Douglas S. DePodesta, Special Agent-in-Charge of the Chicago Field Office of the FBI; Mario Pinto, Special Agent-in-Charge of the Chicago Division of the U.S. Department of Health and Human Services, Office of Inspector General; Jason Sargenski, Special Agent-in-Charge of the Department of Defense, Office of Inspector General, Defense Criminal Investigative Service, Southeast Field Office; and Kwame Raoul, Illinois Attorney General. The government was represented by Assistant U.S. Attorneys Kavitha Babu and Hayley Altabef.
“When physicians submit fraudulent claims to federal health care programs, they divert taxpayer-funded resources away from those who truly need them,” said U.S. Attorney Boutros. “Dr. Ghosh’s fraud scheme was particularly egregious because she endangered the health of her patients by performing unnecessary medical procedures, including procedures that severely limited some patients’ ability to have children in the future. We applaud the victims’ strength to come forward and confront this defendant. Our Office will fight tirelessly for victims and work diligently with our law enforcement partners to safeguard taxpayer funds and hold accountable those who steal from the American public.”
“Dr. Ghosh spent years traumatizing patients, lying to insurers, and stealing taxpayer money to feed her greed,” said FBI SAC DePodesta. “The depraved conduct uncovered in this case represents an extreme betrayal of trust toward patients who were simply seeking care and integrity from their doctor. The FBI will continue to aggressively pursue and hold accountable any medical professional who seeks to harm patients for their personal enrichment.”
“Physicians and other medical professionals who place profits ahead of patient care do so at the expense of the very people they swore an oath to protect,” said HHS-OIG SAC Pinto. “The sentence imposed in this case reflects the severity of the defendant’s crimes and the harm inflicted on numerous patients. This investigation underscores our agency’s commitment to aggressively pursuing those who fraudulently submit claims to federal health care programs and put patients at risk.”
“It is imperative that our service members have full confidence that the medical care they receive is both legitimate and delivered by healthcare providers who are unwaveringly committed to their well-being,” said DCIS SAC Sargenski. “Today’s outcome should reassure the public that DCIS, alongside our investigative partners, remains steadfast in our pursuit of those who harm the health, safety, and readiness of our men and women in uniform.”
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