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United States v. Mona Ghosh · редакция 1 → 2 · зафиксировано 2026-09-17 03:50 · +49 −49 lines

## In the
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## ARGUED MAY 14,2026—DECIDED JULY 31,2026
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Before RIPPLE, SCUDDER, and ST.EVE, Circuit Judges.
## ARGUED MAY 14, 2026 — DECIDED JULY 31, 2026
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Before RIPPLE, SCUDDER, and ST. EVE, Circuit Judges.
RIPPLE, Circuit Judge. Mona Ghosh pleaded guilty to two counts of health care fraud. She had practiced medicine in the fields of obstetrics and gynecology and, in the course of her work, she had billed insurance providers for services which she did not provide or which were not medically necessary. In this appeal, she contends that the district court erroneously denied her a sentence reduction for accepting responsibility, erroneously applied a sentence enhancement for conscious or
About two months after Dr. Ghosh pleaded guilty, the State of Illinois filed a professional complaint against her. The Illinois Department of Financial and Professional Regulation (Department of Professional Regulation) filed a complaint seeking to have Dr. Ghosh’s physician’s license revoked. The complaint cited paragraphs from the plea agreement in which
3Id. at 45:03–11.
4Id. at 46:17–24.
3 Id. at 45:03–11.
4 Id. at 46:17–24.
No. 25-2054 she admitted to “knowingly submitt[ing] fraudulent claims … for medically unnecessary procedures and tests ….”5
5 Appellant’s App. 35.
6Id. at 35, 39.
7Id. at 39.
6 Id. at 35, 39.
7 Id. at 39.
No. 25-2054
9 R.95 at 467:06–10 (citing United States v. Mohsin, 904 F.3d 580, 584 (7th Cir. 2018)).
10Id. at 470:22–25.
11Id. at 471:18.
10 Id. at 470:22–25.
11 Id. at 471:18.
No. 25-2054 merely following a form response.”12 The court also noted Dr. Ghosh’s answers during the change-of-plea hearing where she made “repeated efforts to deflect blame for the billing in this case.”13
The court determined that Dr. Ghosh’s total offense level was 30, which yielded a Guidelines range of 97 to 121 months’ imprisonment. The court then analyzed the § 3553(a) factors, beginning with the nature and circumstances of the offense. The court characterized her offense as “serious” because she did “not merely bill insurance companies for services that [she] did not provide ….”14 The “heart” of the case was not billing fraud but the “women, mothers, sisters, daughters,” who wanted to become pregnant but could not because of the ablations.15 The court determined that Dr. Ghosh’s history and characteristics were “neutral.”16 She had no criminal history and was a nonviolent offender who had a difficult childhood and had experienced abuse from a family member. She excelled in school and became an obstetrics and gynecology physician after becoming a naturalized citizen. She received “numerous” letters of support.17 But she used the money from her fraudulent billing to “support [her] lifestyle, including multiple tens of thousands of dollars in luxury brand
12Id. at 475:20–22.
13Id. at 477:04.
14Id. at 483:14, 483:21–22.
15Id. at 484:16–20.
16Id. at 489:07.
17Id. at 490:10–11.
12 Id. at 475:20–22.
13 Id. at 477:04.
14 Id. at 483:14, 483:21–22.
15 Id. at 484:16–20.
16 Id. at 489:07.
17 Id. at 490:10–11.
No. 25-2054 purchases.”18 The court then concluded that a 120-month sentence with two years of supervised release was appropriate.
A
Dr. Ghosh first contends that the district court should have granted her a reduction in her offense level for accepting responsibility under § 3E1.1. A district court’s denial of a reduction for accepting responsibility under § 3E1.1 is a factual finding subject to clear error review.19 “A defendant who falsely denies, or frivolously contests, relevant conduct that the court determines to be true has acted in a manner inconsistent with acceptance of responsibility, but the fact that a defendant’s challenge is unsuccessful does not necessarily establish that it was either a false denial or frivolous.” U.S.SENT’G GUIDELINES MANUAL § 3E1.1 cmt. 1(A) (U.S.SENT’G COMM’N 2018). The district court is “better equipped to ‘assess whether a particular defendant is motivated by genuine acceptance of responsibility or by a selfserving desire to minimize his own punishment.’” United States v. Major, 33 F.4th 370, 382 (7th Cir. 2022) (quoting United States v. Cunningham, 103 F.3d 596, 598 (7th Cir. 1996)). When making this finding, “the sentencing judge is required to look beyond formalistic expressions of culpability and to determine whether the defendant has manifested an acceptance of personal responsibility for his offense in a moral sense.” Id.
18Id. at 493:02–03.
19United States v. Robinson, 942 F.3d 767, 770 (7th Cir. 2019) (citation modified).
Dr. Ghosh first contends that the district court should have granted her a reduction in her offense level for accepting responsibility under § 3E1.1. A district court’s denial of a reduction for accepting responsibility under § 3E1.1 is a factual finding subject to clear error review.19 “A defendant who falsely denies, or frivolously contests, relevant conduct that the court determines to be true has acted in a manner inconsistent with acceptance of responsibility, but the fact that a defendant’s challenge is unsuccessful does not necessarily establish that it was either a false denial or frivolous.” U.S. SENT’G GUIDELINES MANUAL § 3E1.1 cmt. 1(A) (U.S. SENT’G COMM’N 2018). The district court is “better equipped to ‘assess whether a particular defendant is motivated by genuine acceptance of responsibility or by a selfserving desire to minimize his own punishment.’” United States v. Major, 33 F.4th 370, 382 (7th Cir. 2022) (quoting United States v. Cunningham, 103 F.3d 596, 598 (7th Cir. 1996)). When making this finding, “the sentencing judge is required to look beyond formalistic expressions of culpability and to determine whether the defendant has manifested an acceptance of personal responsibility for his offense in a moral sense.” Id.
18 Id. at 493:02–03.
19 United States v. Robinson, 942 F.3d 767, 770 (7th Cir. 2019) (citation modified).
No. 25-2054 (quoting Cunningham, 103 F.3d at 598). “Attempting to minimize one’s level of involvement in an offense is sufficient to deny a reduction for acceptance of responsibility, even when the defendant has pleaded guilty.” Id. (citation modified).
Dr. Ghosh also points out that her inconsistent statements before the district court were raised for the first time by the
22Id. at 441:24–442:01.
23Id. at 442:02–03.
22 Id. at 441:24–442:01.
23 Id. at 442:02–03.
24 Dr. Ghosh points out in her reply brief that her plea agreement states she “submitted or caused to be submitted fraudulent claims.” R.33 at 3, 5, 6 (emphasis added). Therefore, pointing out that another person handled billing for her was not inconsistent with her plea agreement. However, other admissions in the plea agreement state that she “submitted fraudulent claims” herself. Id. at 4, 5, 6. And her former medical assistant testified that Dr. Ghosh “always” circled, by hand, the billing codes on each of the patients’ encounter forms. R.91 at 32:18.
No. 25-2054 court when it announced her sentence. She relies upon United States v. Jackson, 32 F.3d 1101, 1105 (7th Cir. 1994),where we explained that Federal Rule of Criminal Procedure 32(a)(1) “requires that the court afford the parties ‘an opportunity to comment upon the probation officer’s determination and on other matters relating to the appropriate sentence.’” But Dr. Ghosh agrees that her change-of-plea hearing was her opportunity to demonstrate that she took “complete responsibility.”25 By making statements meant to “manifest[] acceptance,”26 she knew that the district court would consider them when determining whether she had accepted responsibility. The district court is “due great deference because [it] is in a unique position to evaluate a defendant’s words and demeanor in order to determine his acceptance of responsibility.” United States v. Seidling, 737 F.3d 1155, 1162 (7th Cir. 2013). That the district court listened to Dr. Ghosh’s statements and drew a conclusion opposite from the one she now urges upon us does not justify resentencing.
No. 25-2054 court when it announced her sentence. She relies upon United States v. Jackson, 32 F.3d 1101, 1105 (7th Cir. 1994), where we explained that Federal Rule of Criminal Procedure 32(a)(1) “requires that the court afford the parties ‘an opportunity to comment upon the probation officer’s determination and on other matters relating to the appropriate sentence.’” But Dr. Ghosh agrees that her change-of-plea hearing was her opportunity to demonstrate that she took “complete responsibility.”25 By making statements meant to “manifest[] acceptance,”26 she knew that the district court would consider them when determining whether she had accepted responsibility. The district court is “due great deference because [it] is in a unique position to evaluate a defendant’s words and demeanor in order to determine his acceptance of responsibility.” United States v. Seidling, 737 F.3d 1155, 1162 (7th Cir. 2013). That the district court listened to Dr. Ghosh’s statements and drew a conclusion opposite from the one she now urges upon us does not justify resentencing.
Dr. Ghosh also contends that the district court gave too much weight to her filing before the Department of Professional Regulation. She emphasizes that her answer to the Department’s allegations was drafted by a civil attorney whom she retained the same day she received the complaint. She recounts that she reviewed the drafted answer for only sixteen seconds before signing it. Dr. Ghosh furthermore takes issue
25See Appellant’s Br. 16 (“At the plea hearing, Dr. Ghosh acknowledged her guilt … [s]he twice responded that she took ‘complete responsibility.’” (quoting R.107 at 46:17–24)).
26Id.
25 See Appellant’s Br. 16 (“At the plea hearing, Dr. Ghosh acknowledged her guilt … [s]he twice responded that she took ‘complete responsibility.’” (quoting R.107 at 46:17–24)).
26 Id.
No. 25-2054 with the district court’s decision to cite specifically a sentence from the answer in which she stated that KG Patel handled billing for her. In her view, the court should have considered the entire drafting process of the answer or asked whether Dr. Ghosh understood that the answer was inconsistent with her criminal plea agreement.
Section 2B1.1(b)(16)(A) provides for a two-level increase if the offense involved the conscious or reckless risk of death or serious bodily injury. The text of the enhancement “does not define what constitutes ‘the conscious or reckless risk of death or serious bodily injury.’” United States v. Mohsin, 904 F.3d 580, 584 (7th Cir. 2018). We have affirmed the imposition of the enhancement “[i]n a mail fraud case involving false billings for medical procedures to insurance companies ….” Id. (citing United States v. Vivit, 214 F.3d 908, 920–22 (7th Cir. 2000)).
In Vivit, a jury convicted a physician of sixteen counts related to false insurance billing. The jury heard from patients who testified that they had serious medical problems, but that Vivit failed to test or examine them. 214 F.3d at 912. At sentencing, the district court applied the two-level enhancement. In affirming that decision, we explained that the Guidelines employ the phrase “serious bodily injury” to mean “injury involving extreme physical pain or the protracted impairment of a function of a bodily … organ[;] or requiring medical intervention such as surgery, hospitalization, or physical rehabilitation.” Id. at 920 (quoting U.S.SENT’G GUIDELINES MANUAL § 1B1.1 application n. 1(j) (U.S.SENT’G COMM’N 2018)). We upheld the enhancement because Vivit failed to perform physical examinations on patients who consulted him after car accidents. This lapse “created a risk that, had these patients suffered serious injuries, their injuries would
27United States v. Vivit, 214 F.3d 908, 920 (7th Cir. 2000).
In Vivit, a jury convicted a physician of sixteen counts related to false insurance billing. The jury heard from patients who testified that they had serious medical problems, but that Vivit failed to test or examine them. 214 F.3d at 912. At sentencing, the district court applied the two-level enhancement. In affirming that decision, we explained that the Guidelines employ the phrase “serious bodily injury” to mean “injury involving extreme physical pain or the protracted impairment of a function of a bodily … organ[;] or requiring medical intervention such as surgery, hospitalization, or physical rehabilitation.” Id. at 920 (quoting U.S. SENT’G GUIDELINES MANUAL § 1B1.1 application n. 1(j) (U.S. SENT’G COMM’N 2018)). We upheld the enhancement because Vivit failed to perform physical examinations on patients who consulted him after car accidents. This lapse “created a risk that, had these patients suffered serious injuries, their injuries would
27 United States v. Vivit, 214 F.3d 908, 920 (7th Cir. 2000).
No. 25-2054 remain untreated,” and Vivit acted recklessly in ignoring that risk. Id. at 922.
30 Appellant’s Br. 19.
31Id.
31 Id.
32 R.95 at 471:16–18.
Dr. Ghosh submits that the district court overemphasized the harm suffered by the patients, which “pushed the sentence towards the top of the range as though this were a case of violent harm rather than fraud.”35 But the district court recognized her attorney’s argument that the case was about health care fraud. It stated, however, that she “did not merely
34United States v. Aljabari, 626 F.3d 940, 950 (7th Cir. 2010).
34 United States v. Aljabari, 626 F.3d 940, 950 (7th Cir. 2010).
35 Appellant’s Br. 22.
36 R.95 at 483:21–22.
37Id. at 484:08–09.
38Id. at 484:13–16.
39Id. at 484:19–20.
40Id. at 490:10–11.
37 Id. at 484:08–09.
38 Id. at 484:13–16.
39 Id. at 484:19–20.
40 Id. at 490:10–11.
41 Id. at 492:21–24.
AFFIRMED