Bloomfield Hills, MI – 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.
Sophie Toya, 55, a Michigan doctor, 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.
According to court documents and evidence presented at trial, 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 August 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.
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Key Facts
- State: Michigan
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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