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Source: United States Department of Justice Criminal Division

A Michigan doctor was sentenced today to four years in prison for a $6.3 million Medicare fraud scheme in which elderly and disabled patients were sent thousands of orthotic braces that they did not need.

According to court documents and evidence presented at trial, Sophie Toya, M.D., 56, of Bloomfield Hills, prescribed over 7,900 orthotic braces to more than 2,600 Medicare patients during a six-month period. The patients were solicited through deceptive television commercials offering free back braces. When they called the advertised telephone number, they were persuaded to accept braces for other parts of their bodies, with the promise that Medicare would pay. Toya spoke to some of these patients briefly over the phone, and she had no contact at all with the others. Toya nonetheless signed orders prescribing more than 7,900 braces, including prescribing four or more braces to nearly 1,000 patients.

Toya prescribed as many as 136 braces in a day, 12 braces for a single patient, and numerous braces for undercover agents posing as Medicare beneficiaries after speaking with them by telephone for less than a minute. The prescriptions and accompanying medical records signed by Toya 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. In the case of one patient, to whom Toya prescribed five braces for which Medicare was billed $3,883, she falsely attested that she evaluated the patient and that the patient was mobile when, in fact, the patient 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.

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

On May 10, 2024, Toya was convicted following an eight-day trial on one count of health care fraud and five counts of false statements relating to health care matters. Toya 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 health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of 9 strike forces operating in 27 federal districts, has charged more than 5,800 defendants who collectively have billed federal health care 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 health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.

Source: United States Department of Justice Criminal Division

WASHINGTON — A Canadian national accused of operating fraudulent prize notice schemes was extradited to the United States and made his initial appearance in Las Vegas federal court on June 18, the Department of Justice and U.S. Postal Inspection Service announced today.

Patrick Fraser, 44, of Alberta, Canada, will face federal charges of conspiracy and mail fraud. Fraser was arrested on June 15, 2023, by Canadian authorities pursuant to a U.S. extradition request and was surrendered to the United States this month. A detention hearing was held on June 23, and Fraser was ordered detained pending trial.

According to the indictment, the defendant conspired with others to operate fraud schemes through which he mailed fraudulent prize notifications to individuals in the United States and in other countries. The prize notifications falsely represented that the victims had been specifically chosen to receive a large cash prize, typically over $1 million, and would receive the prize upon payment of a small free. Many of the victims were elderly and vulnerable.

“The Justice Department is committed to prosecuting and pursuing those who perpetrate fraud schemes targeting America’s seniors,” said Assistant Attorney General Brett Shumate of the Justice Department’s Civil Division. “I thank Canada for assisting in extraditing this individual to face charges here in the United States. The Justice Department and U.S. law enforcement partners will continue to work closely with law enforcement partners across the globe to bring to justice criminals who attempt to defraud U.S. victims from outside the United States.”

“The U.S. Attorney’s Office will continue to work with the Consumer Protection Branch and our law enforcement partners in the United States and the world to identify and pursue transnational criminals who prey on older Americans,” said U.S. Attorney Sigal Chattah for the District of Nevada. “Through our Elder Justice Initiative, Assistant U.S. Attorneys and professional staff are combating elder financial exploitation and fraud. This extradition is another example of the outstanding collaboration between federal law enforcement and international partners.”

“Postal inspectors protect the vulnerable. If you use fake prize offers to scam others, we’ll find you—and you will be held accountable,” said U.S. Postal Inspector in Charge Eric Shen.

Fraser is charged in a nine-count indictment filed in the U.S. District Court for the District of Las Vegas. If convicted, Fraser faces a maximum penalty of 20 years in prison per count. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

All defendants are presumed innocent until proven guilty beyond a reasonable doubt.

Senior Trial Attorney Ann Entwistle and Trial Attorney Charles B. Dunn of the Justice Department’s Consumer Protection Branch and Assistant U.S. Attorney Richard Anthony Lopez for the District of Nevada are prosecuting the case. USPIS investigated the case. The Justice Department is grateful to the Vancouver Police Department, who provided assistance through official requests. The Office of International Affairs of the Justice Department’s Criminal Division accomplished the extradition of Fraser from Canada.

The Justice Department continues to investigate and bring charges in other similar matters. If you or someone you know is age 60 or older and has experienced financial fraud, experienced professionals are standing by at the National Elder Fraud Hotline: 1-833-FRAUD-11 (1-833-372-8311). This Justice Department hotline, managed by the Office for Victims of Crime, can provide personalized support to callers by assessing the needs of the victim and identifying relevant next steps. Case managers will identify appropriate reporting agencies, provide information to callers to assist them in reporting, connect callers directly with appropriate agencies, and provide resources and referrals, on a case-by-case basis. Reporting is the first step. Reporting can help authorities identify those who commit fraud and reporting certain financial losses due to fraud as soon as possible can increase the likelihood of recovering losses. The hotline is open Monday through Friday from 10:00 a.m. to 6:00 p.m. ET. English, Spanish, and other languages are available.

More information about the department’s efforts to help American seniors is available at its Elder Justice Initiative webpage. For more information about the Consumer Protection Branch and its enforcement efforts, visit www.justice.gov/civil/consumer-protection-branch. Consumer complaints may be filed with the FTC at www.reportfraud.ftc.gov/ or at 877-FTC-HELP. The Justice Department provides a variety of resources relating to elder fraud victimization through its Office for Victims of Crime, which can be reached at www.ovc.gov.

For more information about the Consumer Protection Branch and its fraud enforcement efforts, visit www.justice.gov/civil/consumer-protection-branch.