Thursday, October 29, 2020

Florida doctor charged in $681M addiction treatment fraud scheme


A Delray Beach doctor who once tried to distance himself from a sober home that federal investigators said preyed on young addicts and scammed insurers out of tens of millions of dollars is now facing charges that he was deeply involved in such schemes at 50 addiction treatment facilities — on a scale that reached $681 million.

In what appears to be the largest such case to date, Dr. Michael J. Ligotti has been arrested and charged with conspiring to commit health care fraud and wire fraud for his alleged role in a nine-year scheme to fraudulently bill for tests and treatments of vulnerable patients seeking a path out of drug and alcohol addiction, the U.S. Department of Justice announced Friday.

“As is always the case with any criminal matter, the burden of proof rests entirely with the government. And in this instance, we do not believe the U.S. Department of Justice’s claims — and that is exactly what they are at this point, just one-sided claims — will reconcile with actual evidence at a future trial,” said Ligotti’s attorney Ben Curtis. “Dr. Ligotti thus looks forward to establishing his innocence.”

According to federal documents, Ligotti has been a licensed osteopathic physician since 2003, and two years later, at the age of 31, opened a private clinic at 402 SE 6th Ave. in Delray Beach called Whole Health.

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The clinic offers family care, urgent care, but primarily addiction treatment. Federal investigators contend that from there, Ligotti has played a “central role” in a multi-faceted scheme that worked like this:

For a fee, Ligotti, now 46, would become the purported “medical director” of a sober home or treatment facility, authorizing standing orders for “hundreds of millions of dollars in medically unnecessary urine tests” on patients who carried health insurance.

As an award-winning investigation by The Palm Beach Post revealed in 2015, addicts with insurance and their urine have proven an irresistible combination for unscrupulous players in the addiction treatment industry.

The sober homes would demand urine tests of their clients and bill insurance. The testing labs sometimes paid kickbacks to those facilities, but in order to prescribe the testing, the operators needed a doctor’s signature.

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Authorities say that in exchange for his signature on these standing orders, Ligotti required their patients be treated by Whole Health and his staff. That allowed him to turn around and bill insurance directly for “hundreds of millions in additional treatments,” according to the department’s statement.

They say Ligotti billed for urine tests, blood tests, office visits and therapy sessions — whether they were needed or not, and whether or not they actually happened.

From May 2011 through March 2020, Ligotti did this for more than 50 addiction treatment facilities and signed more than 136 standing orders authorizing fraudulent tests, according to the federal government.

“Some patients allegedly were billed between $10,000 and $20,000 by Ligotti and Whole Health for a single day’s visit,” the Department of Justice said in announcing his arrest.

They report Ligotti also used multiple nurse practitioners and other employees in his practice to fraudulently bill patient’s private insurance. They also contend that he improperly prescribed drugs, including “large quantities” of opiates and treated more patients than the law permits.

Investigators concluded Ligotti fraudulently billed private insurers and Medicare for laboratory testing claims and other services totalling roughly $681 million, for which they paid about $121 million.

“The charges announced today demonstrate the Department of Justice’s continued resolve to dismantle substance abuse treatment fraud schemes and prosecute those who exploit vulnerable patients seeking help for their substance abuse problems,” said acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division.

The case was investigated by the Palm Beach County office of the FBI with the assistance of the IRS, the Drug Enforcement Administration, the Palm Beach County State Attorney’s Office, as well as the Amtrak Office of the Inspector General.

Authorities are asking anyone who believes they have been a victim of or have information about Ligotti or Whole Health should email [email protected]. and use the title “Ligotti Whole Health” in the title of the email when submitting complaints and/or other information regarding this case.

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