Fraud by Design Is the Real Epidemic Undermining American Healthcare

The sentencing of Dr. Mona Ghosh to ten years in federal prison spotlights a pernicious trend in American healthcare: financial exploitation facilitated by the erosion of clinical ethics. However, this case, though deeply disturbing, fits into a broader systemic crisis where unchecked billing manipulation harms both patients and the integrity of medicine.

Building a Culture that Values Patients, Not Profit

The Ghosh case echoes other high-profile scandals involving obstetrician-gynecologists driven by financial incentives, such as the Virginia physician found guilty of unnecessary hysterectomies and Tennessee gynecologists accused of abusive billing and procedure misuse. Such incidents expose a systemic failure in embedding clinical ethics into daily practice, allowing profit motives to distort patient care. The Ghosh scandal exemplifies how vulnerable populations, like Medicaid recipients, TRICARE members, bear the brunt when oversight succumbs to unchecked self-interest. It is clear that an urgent cultural transformation is needed inside medicine: patient well-being must be re-established as the north star guiding clinical decisions, no matter the financial stakes.

The Scale of the Fraud Epidemic

Fraudulent schemes like Dr. Ghosh’s are alarmingly commonplace. The National Health Care Anti-Fraud Association estimates fraud alone costs tens of billions annually, and some place the broader category of fraud, waste, and abuse as high as 30 percent of total U.S. health care spending, over $1 trillion a year. In fiscal year 2023, agencies recovered only about 3.4 billion dollars, even as over 1.8 billion dollars was recovered under the False Claims Act. These figures illustrate both the staggering losses and the impossibility of policing every corrupt act. Dr. Ghosh’s $1.5 million restitution is a drop in the ocean of systemic leakage. Policymakers must implement more robust deterrence strategies that exceed punitive measures, stressing prevention and cultural cohesion.

Reform Must Transcend Enforcement

While sentencing is an important deterrent, it is not enough. Surveillance and regulation have improved, analytics uncovered 1.1 billion dollars in fraudulent telehealth claims in one Department of Justice sweep, yet the gap remains. To truly change course, focus must shift from policing to prevention:

1. Institutional safeguards: Clinics should integrate internal compliance teams empowered to audit billing and recordkeeping, reporting directly to boards. Experts like former prosecutor Melissa Jampol emphasize that compliance must be insulated from profit pressures.

2. Data-driven patient activation: Emerging tools like “patient receipts” such as summaries patients review and confirm, help identify anomalies early and foster transparency.

3. Professional accountability: Licensing boards must treat willful fraud as clinical malpractice, entering such offenses on public record and accelerating revocation procedures.

4. Whistleblower incentives: Ghosh self-incriminated, but many frauds remain hidden until patients or staff speak out. Reinforcing qui tam provisions under the False Claims Act can empower witnesses to come forward.

Reclaiming Trust in Medicine

The central injury in these cases is far more than financial. Patients intrinsically trust physicians to act in their best interests. When doctors exploit that trust, as Dr. Ghosh allegedly did, performing invasive procedures without consent, the harm is existential. Even worse, forfeiting reproductive autonomy destabilizes individuals and families. Successfully prosecuting such cases is morally necessary but insufficient. Restoring trust requires sustained ethical reinforcement within the profession.

A Call to True Stewardship

The Ghosh verdict underscores the limits of purely punitive enforcement. The challenge now is structural: reengineering systems to reward patient-centered care and count on transparency and accountability. The Department of Justice, Federal Bureau of Investigation, and Department of Health and Human Services playing a critical role in prosecution shows determination, but detention is only one piece. To protect future patients and preserve medicine’s integrity, reformers must infuse frontline institutions with ethics-driven cultures, rigorous internal oversight, and data-backed patient engagement.

If U.S. healthcare is to revert from transactional sharp practice toward one of professionalism and stewardship, our response must combine justice with transformation. Only then will tragedies like Dr. Ghosh’s become relics of a past we have chosen to rectify, not patterns we reluctantly tolerate.