Michigan Doctor Sentenced to 4 Years in $6.3M Medicare Fraud Case

Dr. Sophie Toya, 56, of Bloomfield Hills, Michigan, was sentenced to four years in prison for a $6.3 million Medicare fraud scheme involving unnecessary orthotic braces prescribed to elderly and disabled patients. Toya prescribed over 7,900 orthotic braces to more than 2,600 Medicare patients during a six-month period. Patients were solicited through deceptive TV commercials offering free back braces. Toya had minimal or no contact with patients, yet signed orders prescribing multiple braces per patient, falsely representing medical necessity and patient evaluations.

• Prescribed as many as 136 braces in a single day.
• Prescribed 12 braces for a single patient.
• Prescribed numerous braces to undercover agents after speaking with them for less than a minute.
• Created false medical records claiming evaluations and treatment plans.
• Prescribed five braces costing Medicare $3,883 for a wheelchair-bound patient with a spinal infection requiring surgery, not braces.

Financial Impact

Brace supply companies billed Medicare more than $6.3 million using Toya’s false prescriptions. Toya received approximately $120,000 from purported telemedicine companies for signing the fraudulent prescriptions.

Legal Outcome

On May 10, 2024, Toya was convicted following an eight-day trial on one count of healthcare fraud and five counts of false statements relating to healthcare matters. In addition to prison time, she was ordered to pay $3,606,935 in restitution and $120,475 in forfeiture.

This case is part of the Health Care Fraud Strike Force Program, which, since March 2007, has charged more than 5,800 defendants who collectively billed federal healthcare programs and private insurers over $30 billion.