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Dr. Fraud

medical reimbursement
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

Sadly, it is not uncommon for doctors, nurses, and other healthcare professionals to be the perpetrators responsible for fraudulently billing Medicare for hundreds of millions of dollars each year. (So much for the Hippocratic Oath.) Dr. Michael J Ligotti of Delray Beach, Fl., was recently charged with conspiracy to commit healthcare fraud and wire fraud. He is accused of using his private clinic, Whole Health, to operate a massive health care fraud scheme spanning nearly 11 years.

Whole Health is a private clinic which offers rehabilitation services for those who are seeking to detox and recover from addictive substances. Ligotti is accused of fraudulently billing Medicare and private insurance companies for medically unnecessary tests and treatments. (What Is unnecessary is taking advantage of people looking to better their lives.)

The charges against Ligotti allege that he became the “Medical Director” for addiction treatment facilities and sober homes for a minimal fee, authorized millions of dollars in unnecessary urinalysis tests through labs, and arranged for other treatment facilities and sober homes to have patients treated by Whole Health in exchange for kickbacks. (Sounds like his specialty is not medicine, but fraud.)

Ligottii allegedly served as “Medical Director” for over 50 treatment facilities and authorized the fraudulent billings for over 136 unnecessary urinary analysis tests, blood tests, non-existent therapy sessions, office visits, and other unnecessary services. As you might guess, the performed tests were not medically necessary and were not used as a part of patient treatment. (Imagine finding out the needles you were subjected to were not actually necessary.)

The therapy services Ligotti billed for never occurred as he and his staff were not equipped to provide psychological services. Multiple nurse practitioners and other staff members were also in on the scheme and were directed to bill patient’s private insurance for the unnecessary treatments. (Why stop at defrauding government healthcare programs when you can make more money by also targeting private insurances?)

The complaint against Ligotti also alleges that he prescribed doses of the controlled substance Suboxone to patients who did not require it. (Suboxone is a prescription medication used to treat adults who are addicted to or dependent on opioid drugs.) Additionally, the number of prescriptions frequently exceeded the number of patients he was legally authorized to treat. (Should he be legally authorized to treat anyone?)

Billing records purportedly show that some Whole Health patients were billed between $10,000 and $20,000 a day. From May 2011 to March 2020 private insurance companies and Medicare were allegedly charged over $681 million in fraudulent billings. Whole Health was paid $121 million by Medicare and the private insurance agencies.

Keep in mind that the charges against Ligotti are merely an allegation and he is presumed innocent until proven guilty beyond a reasonable doubt in a court of law. (It’s up to the judicial system to decide his fate.)

Today’s Fraud of the Day comes from a Department of Justice press release, “Florida Doctor Charged in Massive $681 Million Substance Abuse Treatment Fraud Scheme,” on July 31, 2020.

A Palm Beach County, Florida doctor was arrested and charged with conspiring to commit health care fraud and wire fraud for his alleged participation in a massive years-long health care fraud scheme throughout Palm Beach County, billing for fraudulent tests and treatments for vulnerable patients seeking treatment for drug and/or alcohol addiction.

In a criminal complaint unsealed Thursday, Michael J. Ligotti, D.O, 46, of Delray Beach, Florida, was charged with conspiracy to commit health care fraud and wire fraud.  Ligotti made his initial appearance today before U.S. Magistrate Judge Bruce E. Reinhart in the Southern District of Florida.

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