The Seventh Circuit Court of Appeals has upheld a 120-month prison sentence for Dr. Mona Ghosh, who pleaded guilty to two counts of health care fraud. The ruling, issued on July 31, 2026, affects Ghosh's medical career and highlights the serious consequences of fraudulent practices in the healthcare industry.
Dr. Ghosh, a former obstetrician-gynecologist from Hoffman Estates, Illinois, was found to have submitted fraudulent claims to insurance providers, including Medicaid and Tricare, for medical services that were either not provided or not medically necessary. This case serves as a reminder of the legal repercussions for healthcare professionals who engage in fraudulent activities.
Background
Mona Ghosh operated Progressive Women’s Healthcare, S.C., where she practiced obstetrics and gynecology. Between February 2018 and April 2022, she participated in a scheme that involved billing for telemedicine visits she did not conduct and for unnecessary medical procedures, including endometrial ablations. Ghosh was reimbursed over $2.4 million for these fraudulent claims.
Initially facing thirteen counts of health care fraud, Ghosh entered a plea agreement and pleaded guilty to two counts. The charges included submitting a claim for a telemedicine visit that never occurred and billing for lab tests that were not medically justified. Her plea agreement led to a professional complaint filed against her by the Illinois Department of Financial and Professional Regulation, seeking to revoke her medical license.
The Ruling
The Seventh Circuit, led by Judge Ripple, affirmed the district court's decision regarding Ghosh's sentence. The court ruled that Ghosh was not entitled to a sentence reduction for accepting responsibility, as her statements during the plea hearing indicated a lack of genuine acceptance of her actions. The court noted, "Dr. Ghosh’s response to the Department of Professional Regulation’s complaint in which she denied conduct to which she had admitted in the plea agreement prevented the conclusion that she had accepted responsibility."
Additionally, the court upheld the district court's decision to apply a two-level enhancement for conscious or reckless risk of serious bodily injury. The ruling highlighted that Ghosh's actions created a substantial risk to her patients, stating, "It was 'reckless' to perform the ablations without the patients’ knowledge or consent and then to accept payments for the procedures." The court emphasized the gravity of her actions, which not only involved fraudulent billing but also put patients' health at risk.
Impact
This ruling has significant implications for healthcare professionals and the legal system. It reinforces the idea that healthcare fraud is a serious offense that can lead to substantial prison sentences. The decision serves as a warning to others in the medical field about the consequences of engaging in fraudulent practices.
Moreover, the case sets a precedent regarding the standards for accepting responsibility in criminal cases. The court's emphasis on the need for genuine accountability from defendants may influence future cases involving healthcare fraud and similar offenses.
What's Next
Details were not available in the court filing regarding whether Dr. Ghosh plans to appeal the ruling. However, given the serious nature of the charges and the substantial evidence against her, any potential appeal would likely face significant challenges.