January 11, 2023 Newswires

Florida doctor gets 20 years for urine-testing scheme that cost insurers $125 million

Miami Herald (FL)

In one of South Florida’s biggest healthcare fraud cases, an osteopathic physician approved medically unnecessary urine tests and treatment for patients suffering from alcohol and drug addiction that cost private insurance companies more than $125 million over a decade.

Michael Ligotti, who owned a medical clinic in Delray Beach that profited from the scheme, was sentenced Monday to a maximum sentence of 20 years in prison in Miami federal court by U.S. District Judge Rodolfo Ruiz. He had pleaded guilty in October to conspiring to commit healthcare and wire fraud and was ordered to surrender his Florida medical license.

Ligotti, 48, must turn himself into prison authorities in June, but he still faces a restitution hearing to determine how much money the physician must repay Blue Cross/Blue Shield, Humana and other major private insurers for their losses.

According to court records, Ligotti authorized “fraudulent” urine drug tests for patients at about 50 substance abuse treatment centers, sober homes and laboratories in South Florida. In exchange, many of those same patients were recycled through his Delray Beach medical facility, Whole Health, allowing his practice to bill for and profit from redundant substance-abuse treatment and testing services. Ligotti also served as the medical director for some of the treatment centers, sober homes and labs, which were located mainly in Palm Beach County. federal authorities said.

As part of his plea agreement, Ligotti admitted to signing “standing orders” for expensive and unnecessary urine drug tests for patients at the various treatment facilities, including his own clinic. In turn, the patients’ urine specimens were sent to testing laboratories, which then billed private healthcare insurers for the unnecessary urine drug tests. A single test cost thousands of dollars.

As a result, between 2011 and 2020, the healthcare insurers were billed more than $746 million for unneeded addiction treatment and urine testing, according to Justice Department prosecutors. In total, the insurers paid about $127 million for fraudulent drug tests and addiction treatment stemming from Ligotti’s central role in the healthcare scheme, prosecutors said.