A federal jury convicted a Michigan doctor 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, MD, 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.
