Healthcare Facility Rx Drug Diversion – Healthcare Fraud – Sober Homes
A Florida doctor was sentenced today to 20 years in prison for engaging in a massive multi-year scheme to bill health care benefit programs for fraudulent tests and treatments for vulnerable patients seeking treatment for drug and/or alcohol addiction. This case was brought as part of the Department of Justice’s Sober Homes Initiative.
“For nearly a decade, Michael Ligotti exploited vulnerable patients seeking addiction treatment, a reprehensible abuse of trust by a physician,” said Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division. “This defendant will now serve many years in federal prison for using his medical license to authorize fraudulent tests and treatments for addicted patients at treatment centers and sober homes throughout South Florida. This marks the largest addiction fraud treatment case ever charged by the Department of Justice, demonstrating our continuing commitment to tackling health care fraud throughout the country.”
According to court documents, Michael J. Ligotti, D.O., 48, of Delray Beach, served as Medical Director or Authorizing Physician for over 50 sober homes, substance abuse treatment facilities, and clinical testing laboratories in the Palm Beach County area, often signing standing orders for expensive, medically unnecessary urine drug tests for patients at various addiction treatment facilities. These facilities routinely sent patients’ urine specimens to clinical testing laboratories, which then billed health care benefit programs for unnecessary urine drug tests, often thousands of dollars for a single test. In exchange for Ligotti’s authorization of these urine drug tests, the treatment centers required their patients to regularly visit Ligotti’s clinic, Whole Health LLC, for additional treatment and testing, or allowed Ligotti’s staff to come to their facilities to conduct tests and treatment there. This allowed Ligotti to profit by billing patients’ private health insurance plans for duplicative, medically unnecessary, and expensive urine drug tests, blood tests, and other addiction treatments. As a result of this conduct, which took place from 2011 to 2020, health care benefit programs were billed over $746 million and paid approximately $127 million for fraudulent urine drug tests and addiction treatments. Ligotti pleaded guilty to conspiracy to commit health care and wire fraud in the Southern District of Florida in October 2022 and was ordered today to surrender his medical license.
“The victims are real, and the losses are immense,” said Acting Special Agent in Charge Chad Yarbrough of the FBI Miami Field Office. “Instead of ensuring the proper treatment of the vulnerable patients under his care in over 50 sober homes, Michael J. Ligotti gamed the system for millions of dollars in ill-gotten gains. The investigators who unraveled this scam are to be commended for their diligence and commitment. The FBI and our partners will continue to pursue those individuals who use our health care system to prey on the vulnerable and steal from the taxpayers.”
“The results in this case reinforce our commitment and determination to pursue those who would defraud Amtrak’s health care programs and target vulnerable populations,” said Special Agent in Charge Mike Waters of the Amtrak Office of Inspector General’s Eastern Field Office. “Our agents will continue to work closely with the task force and partner agencies to hold perpetrators accountable and protect Amtrak’s resources, its employees, and their dependents.”
The FBI Miami Division Palm Beach Resident Agency, with assistance from DEA West Palm Beach Diversion Group; IRS Criminal Investigation Miami Field Office; Amtrak Office of Inspector General; Department of Labor ERISA; Florida Department of Financial Services, Division of Investigative and Forensic Services; and Palm Beach County Office of the State Attorney investigated the case.
Senior Litigation Counsel James V. Hayes and Trial Attorney Ligia M. Markman of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Alexandra Chase, Chief, Transnational, Trafficking & Cyber Crimes Unit for the Southern District of Florida prosecuted the case.
The National Rapid Response Strike Force, Los Angeles Strike Force, and Miami Strike Force of the Criminal Division, Fraud Section, and the U.S. Attorneys’ Offices for the Southern District of Florida and Central District of California lead the Department of Justice’s Sober Homes Initiative, which was initiated in September 2020 to prosecute defendants who exploit vulnerable patients seeking treatment for drug and/or alcohol addiction. Since its inception, the Sober Homes Initiative has resulted in charges and guilty pleas or convictions involving 28 criminal defendants in two judicial districts in connection with over $1 billion in alleged false billings for fraudulent tests and treatments for vulnerable patients seeking treatment for drug and/or alcohol addiction.
Tags: Arrests Healthcare Fraud Medically Unnecessary Provider Arrest Sober Homes