Doctor Convicted of $6.3M Medicare Fraud Scheme

A federal jury convicted a Michigan doctor today for causing the submission of over $6.3 million in fraudulent claims to Medicare for medically unnecessary orthotic braces ordered through a telemarketing scheme.

According to court documents and evidence presented at trial, Sophie Toya, M.D., 55, of Bloomfield Hills, signed thousands of prescriptions for orthotic braces for over 2,500 Medicare patients during a six-month period. Toya was not the treating physician for any of these patients and, instead, was connected with some of the patients over the telephone through a telemarketing scheme and spoke to the patients briefly before signing orthotic brace prescriptions for them. For other patients, Toya signed prescriptions without having any contact with them. In one instance, Toya prescribed a lower back brace, right and left shoulder braces, a right wrist brace, right and left knee braces, and right and left ankle braces for a single Medicare patient. Toya also prescribed multiple braces for undercover agents posing as five different Medicare patients after speaking to each agent for less than a minute over the telephone. The evidence presented at trial showed that Toya could not possibly have diagnosed the patients or determined that the braces were medically necessary for them. Nonetheless, Toya signed medical records and prescriptions for braces that 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. Toya's false prescriptions were used by brace supply companies to bill Medicare more than $6.3 million. Toya was paid approximately $120,000 in exchange for signing the fraudulent prescriptions.

The jury convicted Toya of one count of health care fraud and five counts of false statements relating to health care matters. She is scheduled to be sentenced on Aug. 15 and faces a maximum penalty of 10 years in prison for health care fraud and five years in prison on each of the false statements relating to health care matters counts. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Principal Deputy Assistant Attorney General Nicole M. Argentieri, head of the Justice Department's Criminal Division; Assistant Director Michael D. Nordwall of the FBI's Criminal Investigative Division; and Deputy Inspector General for Investigations Christian J. Schrank of the Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.

The FBI and HHS-OIG investigated the case. 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.

Assistant Chief Rebecca Yuan and Trial Attorney Christopher Wenger of the National Rapid Response Strike Force of the Criminal Division's Fraud Section are prosecuting the case.

The Fraud Section leads the Criminal Division's efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of nine strike forces operating in 27 federal districts, has charged more than 5,400 defendants who collectively have billed federal health care programs and private insurers more than $27 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.