Authorities arrested an Anchorage physician Tuesday evening, alleging he billed Medicaid more than $300,00 for services he never provided.
Dr. Shubhranjan Ghosh, the 39-year-old founder and sole practitioner at Ghosh Psychiatric Services, was charged by the state with medical assistance fraud, scheme to defraud and evidence tampering. He primarily treats children, according to a charging document filed in the case.
The arrest comes after a string of charges connected to Medicaid in what the state is calling a continuing "crackdown" on billing fraud. Since October 2012, the Alaska Medicaid Fraud Control Unit has charged 77 individuals with Medicaid fraud, abuse or neglect, compared to about 30 people the decade before, said Andrew Peterson, assistant attorney general.
"It will hopefully serve to save the taxpayers a significant number of dollars," he said.
The investigation into Ghosh Psychiatric Services began in September 2013 when an employee with the South Anchorage office alerted authorities, saying she had "discovered a large fraudulent Medicaid billing issue," according to the charges.
She said she first noticed the fraud in the summer of 2013 when looking at a bill for a patient who was not in the office for the indicated visit, the charges say. She told the office manager, who said he and Ghosh had been submitting false billings "for years" to cover the time spent doing tasks like making phone calls and writing emails for Medicaid-related cases, items they are not compensated for, the charges say.
The employee said the office manager asked her to compile a list of false Medicaid billings because he and Ghosh "had been considering paying it back to Medicaid." She created a spreadsheet for 2011 and 2012, finding that the fraudulent charges totaled about $170,000 and estimated there were about five fraudulent bills each week, according to the charges. But Ghosh and the office manager continued to submit fraudulent bills and did not pay back anything, the charges say.
The office manager told investigators that whenever company finances were down, Ghosh gave him a list of Medicaid recipient names, billing codes and amounts to charge Medicaid. He said Ghosh would just tell him to "bill Medicaid by picking names from random on the Medicaid recipient list," the charges say.
An investigation by federal and state agencies revealed that Ghosh, working with the office manager, was billing Medicaid for three years starting in 2010. He charged more than $110,000 in treatment for his office manager's seven children and $20,000 for Ghosh's ex-girlfriend's children. He then billed Medicaid $170,000 in psychiatric services for patients who never entered the office at the date and time he specified and $42,500 in services while he was traveling, charges said.
One of Ghosh's patients told investigators that he had asked to create false billings for her children. The patient said no and Ghosh "responded that she owed it to him for everything he was doing for her," charges said. Alaska Medicaid billing records said that Ghosh billed Medicaid for more than 40 visits with the patient's two children, according to charges.
Investigation into the prescription monitoring database showed five instances when Ghosh wrote prescriptions to the office manager and his daughter for opiates, according to court documents. The office manager told authorities that his daughter needed a prescription for hydrocodone one time and only needed five pills. He said he and Ghosh split the remainder and all other prescriptions written for him and his daughter. He said he sold his share and Ghosh "kept his share for personal use," charges say.
In September 2013, investigators with the Medicaid Fraud Control Unit executed search warrants at Ghosh's home and business and found more than four ounces of marijuana in his home. Ghosh ultimately pleaded guilty to attempted possession of a controlled substance March 25.
Ghosh is being held on $100,000 bail at Anchorage jail. He is charged with three felonies and one misdemeanor. His pre-indictment hearing is scheduled for Thursday. His office manager has not been charged, but the investigation is ongoing, Peterson said.
The state spends about $1.5 billion on Medicaid each year, a program to provide medical access for low-income Alaskans, Peterson said.
Recently, the state uncovered more than $628,000 in alleged Medicaid fraud at Good Faith Services, charging 45 people connected to the personal care provider. In January, the state prosecuted an employee with the Municipality of Anchorage who falsely billed Medicaid for more than $64,000 in personal care attendant services.
By TEGAN HANLON