Dr. Sophie Toya sentenced in Michigan for massive $6.3M Medicare brace fraud, targeting elderly and disabled patients.

A Bloomfield Hills, Michigan, physician, Dr. Sophie?Toya, 56, received a four-year federal prison sentence on June?26, 2025, for orchestrating a $6.3 million Medicare fraud involving thousands of medically unnecessary orthotic braces. The Justice Department announced that Toya prescribed more than 7,900 braces to over 2,600 elderly and disabled patients in just six months, frequently without any clinical contact or medical necessity.

Fraud operation exploited elderly and disabled patients in Michigan and beyond

Patients were solicited via deceptive television ads offering free back braces. Once they called, operators persuaded them to accept additional braces—arm, leg, or ankle—with claims that Medicare would cover the cost. Toya spoke with some patients briefly; many received prescriptions signed by her without any evaluation .

In one extreme visit, she issued four braces in a single day to one patient and up to 136 braces in a day overall. Some undercover agents posing as beneficiaries received multiple braces after phone consultations lasting less than a minute. In a particularly egregious case, Toya falsely certified a wheelchair-bound patient was mobile and didn’t need surgery, while billing Medicare $3,883 for five braces .

Justice Department underscores telemedicine fraud trend in Michigan

The scheme was prosecuted under Operation Rubber Stamp, a joint federal initiative targeting telemedicine schemes exploiting Medicare. Toya pleaded guilty on May 10, 2024, for one count of health care fraud and five counts of making false statements in health care matters. She also faces over $3.6 million restitution and $120,475 in forfeiture.

The prosecution was led by Assistant Chief Rebecca Yuan and Trial Attorney Chris Wenger from the Justice Department’s National Rapid Response Strike Force. Investigators included the FBI and HHS Office of Inspector General (OIG)—participants in broader telemedicine fraud crackdowns across Michigan.

Expert warns Michigan physicians amid intensified Medicare enforcement

Michigan has seen similar telemedicine-related fraud cases. For example, in Alpena and Dearborn, providers were charged for signing unnecessary equipment orders without patient examinations.

Amanda Hill, a health-care law expert with Hill Health Law Group, says physicians in federal programs must maintain diligent compliance. The DOJ increased enforcement; in 2024 alone, 193 defendants, including 76 medical professionals, were charged for health care fraud—representing $3.26 billion in false claims.

Hill advises that “physicians should think critically about their business arrangements and seek legal counsel to scrutinize payment sources”.

Michigan patients’ care disrupted while taxpayer bills soared

Medicare beneficiaries received braces they didn’t need, potentially hindering genuine medical treatment. The scheme forced taxpayers to cover costs, eroding trust in Michigan’s health care system.

Notably, this sentencing coincides with other high?profile federal Medicare fraud crackdowns. Just this month, CVS Caremark was ordered to pay $95 million over overcharging Medicare Part D prescription drug claims. Also, a separate case involves Eastern European operators accused of a $10.6 billion equipment fraud.

Broader significance for Michigan and Medicare Advantage reforms

This conviction highlights widespread Medicare fraud, especially through telemedicine and durable medical equipment abuse. Experts say such schemes contribute to an estimated $60 billion in improper Medicare payments each year.

Meanwhile, Congress and CMS are debating reforms in Medicare Advantage—addressing “upcoding” and excessive billing in private plans . Michigan beneficiaries may benefit if lawmakers target similar fraud schemes.

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