Doctor Lied That Patients Had Cancer, Defrauded Insurance Companies: Prosecutors

HOFFMAN ESTATES, IL — A local physician has been sentenced to 10 years in federal prison for billing Medicaid and private insurers for nonexistent and unnecessary services. Mona Ghosh, 52, of Inverness, owned and operated Progressive Women’s Healthcare, S.C., a medical office in Hoffman Estates, specializing in obstetrics and gynecology services.

Ghosh pleaded guilty last year to two counts of health care fraud. On Monday, U.S. District Judge Franklin U. Valderrama imposed a 10-year prison sentence and ordered Ghosh to pay approximately $1.5 million in restitution.

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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.

According to prosecutors, some of the procedures were performed without patient consent. Prosecutors said Ghosh told some patients they needed aggressive cancer treatment, even though they did not have cancer, ABC Chicago reported.

In addition, 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 in order to seek higher reimbursement rates. Ghosh prepared false patient medical records to support the fraudulent reimbursement claims.

"When physicians submit fraudulent claims to federal health care programs, they divert taxpayer-funded resources away from those who truly need them," U.S. Attorney Andrew S. Boutros said. "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."

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