On January 9, 2023, the U.S. Department of Justice announced that a federal judge sentenced Florida doctor, Michael Ligotti, to 20 years in prison for his role in a multi-year healthcare fraud scheme that took place from 2011 to 2020. Dr. Ligotti also surrendered his medical license.
Dr. Ligotti was charged with and pled guilty to conspiracy to commit health care fraud and wire fraud in October 2022. According to the government, Dr. Ligotti owned and ran Whole Health, a private clinic that offered addiction treatment, family care, and urgent care services. The government detailed the alleged scheme, noting that Dr. Ligotti “(1) agreed to become the purported “Medical Director” for an addiction treatment facility or sober home for a nominal fee; (2) authorized “standing orders” for hundreds of millions of dollars in medically unnecessary urinalysis tests (UAs), which were billed by testing laboratories that sometimes paid kickbacks to the sober homes or addiction treatment facilities; and (3) in exchange for his signature on these standing orders, required the facilities to have their patients treated by Whole Health…”
The medical services purportedly rendered included urine drug screens and blood tests that the government alleged were for revenue-generation and not patient care. The government also alleged that Dr. Ligotti billed for psychiatric and therapy services that never happened. Dr. Ligotti also improperly prescribed controlled substances and ignored evidence of possible diversion. To execute the fraud, Dr. Ligotti served as the Medical Director or Authorizing Physician for over 50 healthcare facilities/companies, including sober homes, substance abuse treatment facilities, and clinical testing laboratories in Florida. He also used nurse practitioners and medical extenders to fraudulently bill private insurance. The government noted that the scheme let Dr. Ligotti bill hundreds of millions of dollars for fraudulent treatments. Specifically, health care benefit programs were billed over $746 million and paid about $127 million for fraudulent treatments. According to Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division, “This [case] marks the largest addiction fraud treatment case ever charged by the Department of Justice, demonstrating our continuing commitment to tackling health care fraud throughout the country.”
The case was investigated by several federal and local agencies. The investigation and prosecution were part of the DOJ’s Sober Homes Initiative, which targets kickback schemes at substance abuse treatment facilities. The DOJ’s Sober Homes Imitative was created following the enactment of the Eliminating Kickbacks in Recovery Act (EKRA), which prohibits remuneration in return for referring a patient to a clinical treatment facility, recovery home, or laboratory. According to the DOJ, the Sober Home Initiative has resulted in charges and guilty pleas or convictions of 28 criminal defendants in just two judicial districts in connection with over $1 billion in alleged false billings for fraudulent tests and treatments for substance abuse patients.
The attorneys at Chilivis Grubman represent clients of all types and sizes in connection to health care fraud and False Claims Act litigation. If you need assistance with such a matter, please contact us today.