A Bloomfield, Mich.-based physician was sentenced to four years in prison for a $6.3 million Medicare fraud scheme involving medically unnecessary orthotic braces, the Justice Department said in a June 26 news release.
What happened?
- Sophie Toya, MD, prescribed over 7,900 orthotic braces to more than 2,600 Medicare patients over six months.
- Patients were recruited through misleading TV ads offering free back braces. When they called the advertised number, they were encouraged to accept additional braces for other body parts under the assurance that Medicare would cover the cost.
- Dr. Toya briefly spoke with some patients by phone and had no contact with others, yet she authorized prescriptions for thousands of braces, often four or more per patient, including 12 braces for one individual and 136 in a single day. She also prescribed braces for undercover agents posing as Medicare beneficiaries after speaking with them for less than a minute.
- These false prescriptions enabled brace suppliers to bill Medicare for over $6.3 million. In return, Dr. Toya received approximately $120,000 from telemedicine companies for signing the fraudulent orders.
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