News

By Larry Keller

More than two years after his arrest in a massive insurance fraud scheme involving drug treatment centers and sober houses, Delray Beach physician Michael Ligotti has pleaded guilty to a criminal charge that will net him a sentence of up to 20 years in federal prison.
Ligotti, 48, pleaded guilty Oct. 4 to a single count of conspiracy to commit health care and wire fraud. Federal prosecutors dropped 12 other counts of health care fraud and money laundering.
The doctor also could be fined up to $250,000, and with other defendants be held liable for paying $127 million in restitution. He is scheduled to be sentenced Dec. 13.
Ligotti was arrested in July 2020 and subsequently indicted on charges of fraudulently billing private insurance companies and Medicare of approximately $746 million for which they paid $127 million over a span of nine years. He is free on a $1.5 million bond.
The doctor opened Whole Health medical practice at 402 SE Sixth Ave. in 2005. It purported to be an urgent care facility, a family practice and an addiction treatment medical office, but most of its patients were addicted to drugs and alcohol and had private insurance. Ligotti was the only physician, assisted by nurse practitioners and other medical professionals.
Ligotti’s scheme worked like this, according to the government:
Ligotti became the medical director at more than 50 sober homes and treatment facilities. He signed approximately 137 standing orders for these businesses, which then required their patients to submit to urine drug tests three or more times per week on Ligotti’s orders.
These were sent to laboratories, which billed insurers for the tests and paid kickbacks to the sober home and treatment center operators. They in turn would require their patients to regularly visit Ligotti’s Whole Health practice for additional testing and treatment — the clinic had its own in-house lab — or they would permit Ligotti to send staff to them for this purpose.
“This allowed Ligotti to profit by billing patients’ insurance for duplicative, unnecessary and expensive tests and treatments,” prosecutors said in a statement of facts to which Ligotti admitted. The result often was “double-billing the same services for patients at Whole Health that had already been billed by the substance abuse treatment centers, sober homes and/or the clinical testing laboratories.”
A Whole Health nurse practitioner told investigators that sometimes 10 to 15 addiction patients were transported there in vans dubbed “druggy buggies.”
Ligotti and Whole Health ordered urine and blood drug testing so frequently that additional tests were often ordered before any medical professional had received or reviewed the results of earlier tests. And when a patient did test positive for a banned substance, Whole Health and the treatment facilities seldom imposed consequences.
The drug screens were lucrative. Whole Health billed one patient’s insurer more than $840,000 in a little more than six years, and the insurer of another patient $707,000 in less than four years, prosecutors said.
Ligotti also billed insurers for other services, such as psychiatric therapy sessions that didn’t occur and for which Whole Health didn’t have qualified staff.
Ligotti originally had a trial date set for April 2021, but the complexity of the case contributed to its being delayed. In July and August alone, the government produced more than 88,000 pages of documents such as patient charts, billing records, insurance claims and patient interview reports, Ligotti’s lawyer said in court papers. There also was a “voluminous” amount of material released earlier, he said.
The doctor “is drowning in the amount of information he must analyze to get ready for trial, and his attorney is similarly drowning,” the attorney, Jose Quiñon, wrote in late August in a motion seeking a trial continuance of at least six months.
Complicating matters further, one of Ligotti’s three children contracted COVID-19 in August, and then he and his wife also were diagnosed with the virus.
Before his legal woes, Ligotti lived well. His Whole Health practice paid $128,600 to a Boca Raton jewelry store, according to court records.
The doctor and his family lived in a seven-bedroom home on Seagate Drive in Delray Beach, and owned a second six-bedroom house nearby. The homes and the Whole Health building have been sold for a cumulative $9.3 million. Net proceeds after mortgages and other encumbrances have been paid will be forfeited to the government.