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Florida doctor sentenced to 20 years for substance abuse treatment fraud scheme

MIAMI — A Florida doctor was sentenced on Monday to 20 years in prison for engaging in a multiyear scheme to bill health care benefit programs for fraudulent tests -- including unnecessary urine tests -- for patients suffering from alcohol and drug addiction, prosecutors said.

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According to a news release from the U.S. Department of Justice, Michael J. Ligotti, 48, of Delray Beach, cost private insurance companies more than $125 million over nearly a decade with the fraudulent tests and treatments.

Ligotti pleaded guilty in October in the Southern District of Florida to conspiring to commit health care and wire fraud and was ordered to surrender his Florida medical license, the Miami Herald reported.

The case was part of the Department of Justice’s Sober Homes Initiative.

Ligotti was the medical director or authorizing physician for more than 50 sober homes, substance abuse treatment facilities and clinical testing laboratories in South Florida, according to WPTV. According to court documents, Ligotti allegedly billed insurance companies more than $746 million and paid himself approximately $127 million for the fraudulent tests and treatments, according to the television station.

He will be required to surrender to prison authorities in June, but he still faces a restitution hearing to determine how much money he must repay Blue Cross/Blue Shield, Humana and other major private insurance companies, the Herald reported.

According to prosecutors, Ligotti billed patients’ private health insurance plans for “duplicative, medically unnecessary, and expensive urine drug tests, blood tests and other addiction treatments from 2011 to 2020, WPTV reported.

In the scheme, facilities sent patients’ urine specimens to clinical testing laboratories and health care benefit programs, including single tests that cost thousands of dollars, according to the television station.

Prosecutors said Ligotti authorized the fraudulent tests for patients, the Herald reported. In exchange, many of those same patients were redirected to his medical facility in Delray Beach, Whole Health, allowing his practice to bill and profit from redundant services, the newspaper reported.

“The victims are real, and the losses are immense,” Chad Yarbrough, of the FBI Miami Field Office, said in a statement. “Instead of ensuring the proper treatment of the vulnerable patients under his care in over 50 sober homes, Michael J. Ligotti gamed the system for millions of dollars in ill-gotten gains.

“The investigators who unraveled this scam are to be commended for their diligence and commitment. The FBI and our partners will continue to pursue those individuals who use our health care system to prey on the vulnerable and steal from the taxpayers.”