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 allegedly sent thousands of orthotic braces they didn't need, according to the U.S. Department of Justice.
According to court documents and evidence presented at trial, Dr. Sophie Toya, 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, the DOJ said. 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 of these patients briefly over the phone, and she had no contact at all with the others. She nonetheless signed orders prescribing more than 7,900 braces, including prescribing four or more braces to nearly 1,000 patients.
WHAT'S THE IMPACT
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, according to the DOJ.
The prescriptions and accompanying medical records she signed 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, the DOJ said.
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 telehealth companies in exchange for signing the fraudulent prescriptions.
THE LARGER TREND
Toya was convicted on May 10, 2024, following an eight-day trial on one count of healthcare fraud and five counts of false statements relating to health care matters. She was also ordered to pay $3,606,935 in restitution and $120,475 in forfeiture.
The case was charged as part of Operation Rubber Stamp, a coordinated nationwide law enforcement operation that targeted medical professionals who participated in fraudulent telehealth schemes.
Since March 2007, the Health Care Fraud Strike Force Program, currently composed of nine strike forces operating in 27 federal districts, has charged more than 5,800 defendants who collectively have billed federal healthcare programs and private insurers more than $30 billion, the DOJ said.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.