Michigan doctor sentenced to four years for $6.3 Medicare fraud scheme

A Michigan doctor received a four-year prison sentence for orchestrating a $6.3 million Medicare fraud scheme that sent thousands of unnecessary orthotic braces to elderly and disabled patients.

What happened

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. 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 to some patients briefly over the phone and had no contact at all with others. She 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 diagnosed the beneficiaries, had a plan of care for them, and recommended that they receive certain additional treatment.

Going deeper

In one case, 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 health care fraud and five counts of false statements relating to health care matters. The case was charged as part of Operation Rubber Stamp, a coordinated nationwide law enforcement operation that targeted medical professionals who participated in fraudulent telemedicine schemes.

What was said

Acting Assistant Attorney General Brian C. Rabbitt said: "These cases hold accountable those medical professionals and others who have exploited health care benefit programs and patients for personal gain. The cooperative law enforcement actions announced today send a clear deterrent message and should leave no doubt about the department's ongoing commitment to ensuring the safety of patients and the integrity of health care benefit programs, even amid a national health emergency."

Why it matters

This case shows the vulnerability of Medicare beneficiaries to fraudulent telemedicine schemes that exploit their trust and medical needs. The scheme specifically targeted elderly and disabled patients through deceptive advertising, demonstrating how fraudsters manipulate vulnerable populations for financial gain. 

FAQs

How did Medicare initially approve payments for the fraudulent braces?

Medicare relies on documentation submitted by providers, which can be exploited when false information is used.

What safeguards are in place to prevent similar telemedicine fraud?

Enhanced verification, stricter documentation requirements, and AI-driven fraud detection systems are being implemented.

How can Medicare beneficiaries protect themselves from deceptive telehealth ads?

They should verify offers with their primary care provider and avoid giving personal information over unsolicited calls.

Are there legal ways doctors can prescribe medical devices through telemedicine?

Yes, but only after conducting a legitimate evaluation and ensuring the device is medically necessary.