Doctor Charged With Performing Unnecessary Endometrial Ablations

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 counts 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) announced.

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.

“Targeting government and private healthcare programs relied on by the public to maintain their well-being is a serious crime,” Morris Pasqual, Acting U.S. Attorney for the Northern District of Illinois, said in a statement. “In addition to submitting false claims, the allegation that defendant performed medically unnecessary procedures to enrich herself is particularly disturbing. This office will continue to work closely with our law enforcement partners to prosecute those who steal from healthcare programs and who needlessly put patients at risk.”

MedPage Today previously reported on instances of women being pitched endometrial ablation as a simple procedure to relieve heavy menstrual bleeding, which then led to complications, such as heavier bleeding, severe pain, and dangerous scarring. Physicians have raised concerns over improper patient selection and treatment failure when it comes to endometrial ablations.

The U.S. Attorney’s Office for the Northern District of Illinois declined further comment on the case. However, the Federal Bureau of Investigation in Chicago is seeking information from any other potential victims.

In its announcement of the case, the DOJ said that each count of healthcare fraud is punishable by up to 10 years in federal prison, adding that Ghosh is presumed innocent until proven guilty.

Legal counsel for Ghosh did not immediately respond to a request for comment.