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FBI: Local Doctor Involved in $681M Substance Abuse Treatment Fraud

A 46-year-old Palm Beach County doctor has been arrested and charged with conspiring to commit health care fraud and wire fraud, the U.S. Attorney’s Office announced late last week.

Dr. Michael J. Ligotti, of Delray Beach, is accused of billing insurance companies and Medicare for fake tests and treatments for patients seeking treatment for drug and/or alcohol addiction.

From May 2011 through March of this year, his office fraudulently billed about $681 million for laboratory testing claims, and was paid nearly $121 million, according to the criminal complaint.

“The substance abuse treatment fraud allegedly perpetrated by the defendant sacrificed the genuine care of vulnerable patients at a time when they urgently needed a trusted health care provider,” said U.S. Attorney Ariana Fajardo Orshan for the Southern District of Florida.

She went on to say, “Health care providers who allow greed to take precedence over their Hippocratic Oath and participate in these schemes are criminals and will be held accountable for their unscrupulous conduct.”

Dr. Ligotti owned and operated Whole Health in Delray Beach. It was a private clinic that offered addiction treatment, family care and urgent care.

He agreed to serve as “Medical Director” for an addiction facility for a small fee, and then authorized “standing orders” for hundreds of millions of dollars in medically unnecessary urinalysis tests (UAs). Testing labs subsequently billed those procedures and paid kickbacks to the sober homes or addiction treatment facilities.

In exchange for signing those orders, Ligotti required the facilities to have their patients treated by Whole Health and his staff. That policy allowed him to bill for additional fake and unnecessary treatments and services.

However, Ligotti allegedly did not review the results of the tests he ordered, or use the results to treat these patients, the complaint states. Some of the patients allegedly were billed between $10,000 and $20,000 by Ligotti and Whole Health for one visit.

Over the nine-year period, Ligotti allegedly served as “Medical Director” for more than 50 addiction treatment facilities. He also signed over 136 standing orders authorizing these fake tests, according to the complaint.

He is also accused of using several nurse practitioners/medical extenders under his practice to fraudulently bill patients’ private insurance.

Ligotti also improperly prescribed controlled substances, and gave the drugs to patients who did not need them.

“The treatment of addiction helps restore an individual’s independence from drugs and good health, so they can go back to their families and be productive members in our society.” said Special Agent in Charge Kevin W. Carter of the U.S. Drug Enforcement Administration’s (DEA) Miami Field Division.

Carter adds, “Physicians and other medical professionals who hold positions of trust within our communities, will absolutely be held accountable for violations of that trust. The DEA Miami Field Division remains committed to working with our law enforcement partners to safeguard our local communities against those who engage in fraudulent practices that endanger both the health and lives of Floridians.”

Potential victims and those with information related to Ligotti or Whole Health are asked to e-mail ReportML@FBI.GOV. and use the title “Ligotti Whole Health” in the title of the email when submitting complaints and/or other information regarding this case.