A Michigan doctor has been sentenced to four years in prison for a $6.3 million Medicare fraud scheme in which elderly and disabled patients were sent thousands of orthotic braces that they did not need.
According to court documents and evidence presented at trial, Sophie Toya, M.D., 56, of Bloomfield Hills, prescribed over 7,900 orthotic braces to more than 2,600 Medicare patients during a six-month period.
The patients were solicited through deceptive television commercials offering free back braces. When they called the advertised telephone number, they were persuaded to accept braces for other parts of their bodies, with the promise that Medicare would pay.
Toya spoke briefly with some of these patients over the phone, and she had no contact with the others at all. Toya nonetheless signed orders prescribing more than 7,900 braces, including prescribing four or more braces to nearly 1,000 patients.
Toya prescribed as many as 136 braces in a day, 12 braces for a single patient, and numerous braces for undercover agents posing as Medicare beneficiaries after speaking with them by telephone for less than a minute.
The prescriptions and accompanying medical records, signed by Toya, falsely represented that the braces were medically necessary and that she had diagnosed the beneficiaries, developed a plan of care for them, and recommended that they receive certain additional treatment.
In the case of one patient, to whom Toya prescribed five braces for which Medicare was billed $3,883, she falsely attested that she evaluated the patient and that the patient was mobile when, in fact, the patient had long been confined to a wheelchair, could not walk or stand, and was suffering from a dangerous spinal infection that could not be treated by braces but instead required spinal surgery.
Toya’s false prescriptions were used by brace supply companies to bill Medicare more than $6.3 million. Toya was paid approximately $120,000 by purported telemedicine companies in exchange for signing the fraudulent prescriptions.
On May 10, 2024, Toya was convicted following an eight-day trial on one count of healthcare fraud and five counts of false statements relating to healthcare matters. Toya was also ordered to pay $3,606,935 in restitution and $120,475 in forfeiture.
