One day last summer, an employee who billed patients for psychiatrist Dr. Shubhranjan Ghosh allegedly noticed something strange: a series of charges associated with a “patient” who had never been inside Ghosh's Anchorage office.
Prosecutors say the discovery signaled the beginning of the end to what they call a large scheme to fraudulently bill Medicaid, in which Ghosh is charged with three felonies and a misdemeanor.
An employee not named in court documents described a pattern of fraud that involved the doctor and an office manager and took place over the course of a few years, “as a way to receive payment for their time” for Medicaid-related tasks like phone calls and sending emails that are not compensated.
People who falsify medical assistance claims commonly offer a similar justification, according to Andrew Peterson, director of the Medicaid Fraud Control Unit at the state Office of Special Prosecutions and Appeals.
“But the law is clear,” Peterson said. “You can’t knowingly bill for services that aren’t being provided.”
The employee who noticed the discrepancy tipped off Lance Anderson, an MFCU investigator.
A spreadsheet the employee compiled found $170,000 in billings for services not provided from 2011 to 2012, with similar fraud of an unknown amount continuing into 2013. Ghosh's practice allegedly averaged one fraudulent claim per work day during the scheme.
Ghosh is also accused of billing Medicaid more than $110,000 for psychiatric services allegedly provided to his office manager’s children, and more than $20,000 for services he allegedly provided to the children of an ex-girlfriend.
Travel records also indicate that Ghosh billed Medicaid $42,500 for providing psychiatric services to patients in his office while he was traveling out of state and internationally. Ghosh had previously been prohibited from billing Medicaid due to the investigation into his practice.
The Anchorage District Court set Ghosh's bail at $100,000 cash, also requiring an electronic monitor, surrender of his passport and a waiver of Ghosh's rights against extradition for his release. He was arraigned at the Anchorage Jail Wednesday afternoon.
Peterson says the case against Ghosh is part of a continued focus by the Alaska Department of Law on investigating false Medicaid claims. There have been 76 cases over the past 18 month, he said, about half of which are resolved.
Putting a number on the prevalence of Medicaid fraud is difficult, Peterson said. But the FBI estimates 3 to 10 percent of claims are fraudulent, with about $1.5 billion of Medicaid claims filed annually in Alaska.
"Even on the low end, it's a significant problem, it's a huge number," Peterson said.
How does the case against Ghosh fit into that picture?
"It's one of the more significant that I've seen in my 15 months in this job, but by no means is it the biggest we've seen or the biggest we're going to see," Peterson said.