Florida doctor sentenced for substance abuse treatment fraud scheme

 

Date: January 9, 2023

Contact: newsroom@ci.irs.gov

A Florida doctor was sentenced today to 20 years in prison for engaging in a massive multiyear 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.

According to court documents, Michael J. Ligotti, D.O., 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.

IRS Criminal Investigation Miami Field Office, the FBI Miami Division Palm Beach Resident Agency, DEA West Palm Beach Diversion Group, 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.

Assistant U.S. Attorney Alexandra Chase, Chief, Transnational, Trafficking & Cyber Crimes Unit for the Southern District of Florida and Senior Litigation Counsel James V. Hayes and Trial Attorney Ligia M. Markman of the Criminal Division's Fraud Section 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.