A Florida doctor allegedly bilked Medicare and commercial insurers out of $121 million by billing $681 million of fraudulent tests and treatments for substance abuse patients.
Dr. Michael Ligotti was arrested and charged last week with conspiring to commit healthcare fraud and wire fraud for his alleged participation in a massive years-long scheme across Palm Beach County, which reports estimate is home to a more than $1 billion substance abuse treatment industry.
According to a criminal complaint unsealed Thursday, Ligotti would become a "medical director" at an addiction treatment facility or sober home—for a fee—and implement standing orders for hundreds of millions of dollars in unnecessary and duplicative blood and urine tests in exchange for referrals to his Whole Health medical clinic based in Delray Beach. He would allegedly bill payers for therapy that wasn't provided, inadequate or unnecessary and would unlawfully prescribe buprenorphine, of which he distributed more than 265,000 pills to more than 2,800 patients from 2012 to 2020, according to the complaint.
"This massive, multiyear alleged fraudulent billing scheme by a trusted medical professional generated millions of dollars by preying on patients seeking substance abuse treatment," Brian Rabbitt, acting assistant attorney general of the Justice Department's criminal division, said in prepared remarks.
Ligotti was a purported medical director at more than 50 addiction treatment facilities and signed at least 136 standing orders for fraudulent tests. In one 2015 case, Whole Health billed Aetna $25,900 in tests, with an additional $480 for purported therapy and $350 for an outpatient visit fee. This pattern of excessive billing continues to this day, investigators wrote in the complaint.