Indian-American physician held guilty of healthcare billing fraud in US

After Chicago-based ex-billionaire Rishi Shah, India-origin physician Mona Ghosh has pleaded guilty to two counts of healthcare fraud, each carrying a potential penalty of up to ten years in prison

In a case following the conviction of a former Indian-American billionaire for fraud in the US, a 51-year-old Indian-American doctor from Chicago has admitted guilt in a federal healthcare fraud scheme involving billing Medicaid and private insurers for services that were never provided.

Mona Ghosh, who runs Progressive Women’s Healthcare, specialising in obstetrics and gynaecology, has pleaded guilty to two counts of healthcare fraud, each carrying a potential penalty of up to ten years in federal prison. Her sentencing is scheduled for October 22 before US District Judge Franklin U Valderrama.

Federal prosecutors have accused Ghosh of obtaining at least $2.4 million through fraudulent reimbursements. She has admitted to being responsible for more than $1.5 million of these fraudulent claims, with the final amount to be determined at sentencing.

 

From 2018 to 2022, Ghosh and her staff submitted false claims to Medicaid, TRICARE, and other insurers for services that were either not provided or not medically necessary. Some procedures were conducted without patient consent. 

Additionally, Ghosh exaggerated the length and complexity of both in-office and telemedicine visits, using incorrect billing codes to secure higher reimbursement rates. She also falsified patient medical records to support these claims, PTI reported.

Case of Indian-American billionaire’s fraud conviction

In an earlier case, Bloomberg reported the sentencing of Rishi Shah, a former Chicago billionaire, to seven and a half years in prison for a $1 billion fraud involving an advertising startup. This startup, Outcome Health, counted major investors like Goldman Sachs, Google parent Alphabet Inc, and Illinois Governor JB Pritzker’s venture capital firm.

Shah, 38, was convicted of multiple counts of fraud and money laundering. He and two other executives were sentenced in Chicago by US District Judge Thomas Durkin. Prosecutors had sought a 15-year sentence, highlighting Shah’s role in deceiving clients, lenders, investors, and auditors. The fraudulent activities involved taking money for ads that were never placed and misrepresenting the company’s financial health to investors.

Before his fraud was exposed in a 2017 Wall Street Journal article, Shah was a prominent figure in Democratic circles. He founded Outcome Health, initially called Context Media Health, in 2006 while studying at Northwestern University. The company’s swift growth over the next decade significantly raised his public profile, leading then-Mayor Rahm Emanuel to praise the company’s potential impact on Chicago.

[With inputs from PTI]