A doctor in Palm Beach County, FL, was arrested and charged for allegedly participating in a massive health care fraud scheme that involved billing recovering drug and/or alcohol addicts for fraudulent treatments and tests.
Dr. Michael J. Ligotti, 46, of Delray Beach, was charged with conspiracy to commit health care fraud and wire fraud. Attorney information was not available.
According to the criminal complaint, the accused is the owner of a Delray Beach-based private clinic called Whole Health that offered services such as urgent care, family care, and addiction treatment. He is accused of fraudulently billing private insurers and Medicare for an estimated $681 million in laboratory tests and other services, for which they paid approximately $121 million.
The defendant from Florida was purportedly the “medical director” for more than 50 addiction treatment facilities or sober homes for a fee. He allegedly authorized over 136 “standing orders” for urinalysis tests, which were billed by medical laboratories that reportedly paid kickbacks to sober homes. In exchange for authorizing the orders, he required the facilities to supply Whole Health with patients who he and his staff treated, allowing him to bill private insurers and Medicare for additional treatments, the complaint alleges.
“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. “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.”
The alleged treatments that the defendant and his staff provided at Whole Health included expensive blood tests, urinalysis tests, and other unneeded services. The complaint claims the doctor never reviewed the results of the tests in any meaningful way and he never used them to treat the patients. He also allegedly billed insurers for therapy sessions and psychiatric services that never happened and that neither he nor his staff was qualified to perform. Some of the patients were allegedly billed between $10,000 and $20,000 for a single day’s visit.
The complaint further alleges that he inappropriately prescribed patients controlled substances, including large quantities of Suboxone/buprenorphine, often exceeding the number of patients he was legally authorized to prescribe drugs to. He allegedly provided these 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 Kevin W. Carter, Special Agent in Charge of the U.S. Drug Enforcement Administration Miami division. “Physicians and other medical professionals who hold positions of trust within our communities will absolutely be held accountable for violations of that trust.”
Medical billing fraud is the most common form of health care fraud. Many of these cases are based on the assumption that a healthcare clinic deliberately submitted fraudulent billing to Medicaid, Medicare, or a private insurer. However, billing mistakes can occur, and the alleged fraud scheme must be significant before the government steps in. If your business is being investigated for health care fraud, then you should immediately consult an experienced fraud defense attorney. The sooner you reach out to an attorney, the easier it will be to address the allegations.
South Florida Fraud Defense Attorney