A Michigan doctor is spending the next four years in prison for swindling $6.3 million from Medicare through a phony orthotic brace scheme.

According to court documents and evidence presented at trial, Sophie Toya, M.D., of Bloomfield Hills, prescribed more than 7,900 orthotic braces to over 2,600 elderly and disabled Medicare patients during a six-month period. The patients were solicited through deceptive television commercials offering free back braces. When these patients called the advertised telephone number, they were persuaded to accept braces for other parts of their bodies, with the promise that Medicare would pay. Dr. Toya spoke to some of these patients briefly by phone, and she had no contact with the others. Dr. Toya nonetheless signed orders prescribing more than 7,900 braces, including prescribing four or more braces to nearly 1,000 patients.

Dr. Toya prescribed as many as 136 braces in one day, 12 braces for a single patient, and numerous braces for undercover agents posing as Medicare beneficiaries after speaking with them by phone for less than a minute. The prescriptions and accompanying medical records signed by Dr. Toya falsely stated the braces were medically necessary, that she diagnosed the beneficiaries, created a plan of care for them, and recommended certain additional treatment. Dr. Toya prescribed five braces for one patient (in which Medicare was billed $3,883), and then lied about evaluating the patient and about the patient being mobile. The patient actually 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.

Dr. Toya’s false prescriptions were used by brace supply companies to bill Medicare more than $6.3 million. Dr. Toya was paid approximately $120,000 by purported telemedicine companies in exchange for signing the fraudulent prescriptions.

On May 10, after an eight-day trial, a federal jury convicted Dr. Toya of one count of healthcare fraud and five counts of false statements relating to healthcare matters. Dr. Toya, 56, was also ordered to pay $3,606,935 in restitution and $120,475 in forfeiture.

Matthew R. Galeotti, Head of the Justice Department’s Criminal Division; Assistant Director in Charge Jose A. Perez of the FBI Criminal 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 Chris Wenger of the National Rapid Response Strike Force of the Criminal Division’s Fraud Section prosecuted the case.

The Fraud Section leads the Criminal Division’s efforts to combat healthcare 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 5,800 defendants who collectively have billed federal healthcare programs and private insurers more than $30 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to hold providers accountable for their involvement in healthcare fraud schemes.