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Chicago OB-GYN Pleads Guilty To Defrauding Medicaid And Private Insurers




Obstetrics and gynecology are two vitally important aspects of health care for women.  Obstetrics focuses on pregnancy, childbirth and the postpartum period. Gynecology treats diseases associated with the female reproductive organs. Together, obstetrics and gynecology combine a surgical field known as OB-GYN.

 

OB-GYN focuses on all aspects of sexual health. They include preventive care, cancer screenings and physical exams. Some of the services and tests provided are pelvic exams, external genital exams, pap tests and cancer screenings.

 

Chicago OB-GYN pleads guilty to federal health care fraud charges.

 

As reported by the Northern District of Illinois branch of the U.S. Attorney’s Office, this past Monday, Mona Ghosh recently pleaded guilty to two counts of health care fraud.  The 51 year-old resident of Inverness, Illinois admitted to billing Medicaid and private insurers for nonexistent services.

 

According to the report, Ghosh owned and operated Progressive Women’s Healthcare, S.C. Located in Hoffman Estates, Illinois, the clinic specializes in obstetrics and gynecology services.  Ghosh admitted that between 2018 and 2022, she both submitted and caused her employees to submit fraudulent claims to Medicaid, TRICARE and numerous other insurers. The claims were for procedures and services that were not provided or were not medically necessary. Some procedures and services were performed without patient consent. 

 

Ghosh falsified information about patient visits.

 

The U.S. Attorney’s Office explains that Ghosh overstated the length and complexity of her in-office and telemedicine visits. She also submitted claims using billing codes for which the visits did not qualify. Ghosh’s plea agreement reveals that her objective was to seek higher reimbursement rates. The statement also confesses that she prepared false patient medical records to support the fraudulent reimbursement claims.

 

Tanya Savkoor covered the story for SheThePeople. “The indictment claimed Ghosh billed government programs like Blue Cross Blue Shield and many private insurance companies for purported telemedicine visits in which she did not really speak to the patient and in-office visits and procedures in which she did not really see the patient,” she details, citing CBS News as her source.

 

Savkoor goes on to note that Ghosh filed claims for numerous false diagnoses or procedures that were not medically necessary. They included lab tests and endometrial ablations. This is a procedure in which the lining of the uterus is removed to reduce heavy menstrual bleeding.

 

Ghosh is accountable for at least $2.4 million.

 

“It is the government’s position that Ghosh is accountable for at least $2.4 million in fraudulently obtained reimbursements,” details the U.S. Attorney’s Office report, “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.”

 

Sentencing is scheduled for October 22, 2024. Her two counts of health care fraud are punishable by up to ten years in federal prison each. 

 

Are you an attorney who is currently working a healthcare fraud case?

 

The clinical experts at Allegiant Experts can help you! We coordinate and support courageous whistleblowers that shine lights on fraud, waste and abuse. Contact us today to schedule a complimentary consultation. Please don’t hesitate to give us a call at 407-217-5831. You may also email us at info@allegiantexperts.com.

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