A Michigan-based doctor was found guilty by a federal jury today for instigating the submission of fraudulent claims exceeding $6.3 million to Medicare. These claims were linked to medically unnecessary orthotic braces ordered through a telemarketing scheme.
Court documents and trial evidence revealed that Dr. Sophie Toya, 55, from Bloomfield Hills, signed thousands of prescriptions for orthotic braces for over 2,500 Medicare patients during a six-month period. However, Toya was not the treating physician for any of these patients. She interacted with some patients briefly over the phone through a telemarketing scheme before signing their orthotic brace prescriptions. For other patients, she signed prescriptions without any prior contact.
In one case, Toya prescribed an array of braces including lower back brace, right and left shoulder braces, right wrist brace, right and left knee braces, and right and left ankle braces for a single Medicare patient. She 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 phone.
The trial evidence demonstrated that it was impossible for Toya to have diagnosed these patients or determined that the braces were medically necessary. Despite this fact, she signed medical records and prescriptions falsely indicating that the braces were medically necessary. She also claimed that she had diagnosed the beneficiaries and had planned their care while recommending additional treatment.
Toya's false prescriptions enabled brace supply companies to bill Medicare more than $6.3 million. In return for signing these fraudulent prescriptions, Toya received approximately $120,000.
The jury convicted Toya on one count of health care fraud and five counts of false statements relating to health care matters. Her sentencing is scheduled for Aug. 15 where she could face up to 10 years in prison for health care fraud and five years in prison on each count of false statements relating to health care matters.
The announcement about Toya's conviction was made by 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).
The case was investigated by the FBI and HHS-OIG as part of Operation Rubber Stamp, a nationwide law enforcement operation targeting medical professionals involved in fraudulent telemedicine schemes.
Assistant Chief Rebecca Yuan and Trial Attorney Christopher Wenger from the National Rapid Response Strike Force of the Criminal Division’s Fraud Section are prosecuting the case.
Since March 2007, the Health Care Fraud Strike Force Program has charged more than 5,400 defendants who have collectively billed federal health care programs and private insurers over $27 billion.