A Chicago-area physician is facing healthcare fraud charges after allegedly seeking reimbursement for services that were not provided or not medically necessary, including endometrial ablations.
Mona Ghosh, MD, who owned and operated Progressive Women's Healthcare in Hoffman Estates, has been indicted on 13 countsopens in a new tab or window for her alleged participation in a scheme to defraud both TRICARE and Medicaid, as well as several private insurance companies, the Department of Justice (DOJ) announcedopens in a new tab or window.
Ghosh is alleged to have fraudulently obtained, and caused her practice to obtain, approximately $796,000 in payments. Fraudulent claims reportedly included those for telemedicine visits and office visits/procedures in which Ghosh allegedly did not speak to or see the patient, as well as those for procedures predicated on false diagnoses and medically unnecessary tests and procedures, such as laboratory testing and endometrial ablations.
Among other allegations, the indictment against Ghosh stated that, in order for the physician to submit claims for endometrial biopsies and ablations that were not medically necessary, Ghosh "caused the claims to contain false diagnosis codes for symptoms and diagnoses that patients did not actually have."
The indictment did not include further specifics on the procedures in question, including the endometrial ablations alleged to be medically unnecessary.
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