Michigan Healthcare Fraud is Exploding

Quick Summary:

Recent months have seen a wave of healthcare fraud actions affecting Michigan providers. Federal and state authorities have uncovered schemes in behavioral health, substance abuse treatment, telemedicine/DME, and Medicaid/Medicare billing. These cases (often involving kickbacks, sham telehealth orders, or bogus home care claims) show how vulnerable care programs are to abuse. We break down how these frauds worked, who was involved, and their financial impact. The following sections review key DOJ and OIG enforcement actions (Nov–Dec 2025) and related schemes, with real case details and cited sources.

Michigan Drug and Pharmacy Fraud

Pill-Mill Pain Clinic (Southfield, MI)

The owner of P&A Aftercare (a Southfield “pain clinic”) hired doctors to write thousands of opioid prescriptions for fake patients in exchange for cash. The fake patients (recruited by associates) filled controlled-substance prescriptions and sold the pills illegally, while the clinic billed Medicare/Medicaid for unnecessary “maintenance” medications. Over $20 million was billed for these pointless opioid and support-drug prescriptions. This case (part of a DOJ opioid-fraud takedown) illustrates a familiar pattern: providers using telemedicine or cash-paid “script mills” to inject fake patients and funnel pills into illegal markets. Sources: Justice Department Article

Hamtramck Urgent Care (Detroit area)

A more flagrant case involved a Detroit-area walk-in clinic where Dr. Basil Qandil saw 40–50 “patients” every 30 minutes, prescribing addictive pain drugs almost instantly. In one month alone, Qandil issued over 4,000 opioid prescriptions; he eventually billed Medicare $2.7 million for 37,000+. Qandil has since been criminally charged with illegal prescribing and health-care fraud. The physician saw no legitimate patient – he essentially “signed off” on scripts for anyone who paid cash (some for $800 per visit). This enabled vast illegal diversion of opioids under the guise of medical treatment. Sources: HamTrack Review Article

Okoh Pharmacy Scheme - $6.2 Million - 80 Months Prison

As of Dec 2025, pharmacist Isaiah Okoh of Sterling Heights was sentenced to 80 months in prison for billing Medicare, Medicaid, and private insurers for drugs never dispensed. From 2019 to 2022, Okoh submitted claims for high-reimbursement medicines (such as blood thinners and inhalers) that he didn’t order or have in stock. He and a co-conspirator even forged doctors’ signatures to support the claims. This fraud caused over $6.2 million in losses to federal and private payers. Okoh must pay nearly $4M in restitution. Sources: Justice Department and OIG Statement

Dearborn Heights Fraud - $4M Pharmacy Scheme

In November 2025, Nabil Fakih, owner of a Dearborn Heights pharmacy, was sentenced to 46 months for a similar fraud. Fakih billed Medicare for prescriptions (blood thinners, inhalers) that his pharmacy never had or dispensed. He manipulated inventory records to hide the fraud and diverted proceeds for personal use. His scheme spanned 2011–2017 and caused about $4 million in losses to Medicare. Fakih forfeited properties and paid restitution totaling about $4.7M. Sources: Justice Department and OIG Statement

What do we learn from this Michigan Pharmacy fraud?

These cases illustrate a common fraud model: pharmacies filing fraudulent claims for high-margin drugs without dispensing them, or prescribing high-volume prescriptions they know plans are inundated with. In the quantity and low-dollar-value type of fraud, providers will continue to increase their prescription counts until they are either caught or wisely and deceptively take on another provider into their scheme.

Compliance tip: reconcile prescription claims with actual dispensing records regularly, and audit unusual purchase inventories.

DME and Telemedicine Fraud

Tele-health Braces Fraud

Five Michigan doctors have either pleaded guilty or settled for ordering medically unnecessary orthotic braces and genetic tests by telemedicine, collectively agreeing to pay hundreds of thousands in repayments. One doctor admitted approving 1,300+ unnecessary braces online, resolving civil charges of $295,000. These cases underscore that physicians on telehealth platforms must carefully verify medical necessity to avoid unwittingly laundering kickback schemes. Sources: Justice Department Article

DME and Telemedicine Fraud (Bloomfield, MI)

One of the highest-profile Michigan cases in late 2024 involved telemedicine and durable medical equipment (DME) – specifically orthotic braces. Dr. Sophie Toya of Bloomfield Hills, MI, signed thousands of prescriptions for expensive braces during telehealth calls, though she never examined the patients. For instance, in one case she prescribed 7 different braces (back, shoulder, wrist, knee, ankle) for a single patient after a 1-minute call. She even signed multiple brace orders for undercover agents in brief calls. Sources: Justice Department Article

Psychotherapy & Counseling Schemes

Historically, Detroit-area fraud has also involved behavioral health services. For example, a Michigan clinic owner pleaded guilty to using disabled patients’ IDs to bill Medicare over $3 million for bogus services. This involved submitting claims for therapy services that were never provided and using providers’ IDs without their consent. Fraud like this is typically uncovered when audit or law-enforcement teams spot suspicious billing patterns (e.g., extremely high volume or implausible patient loads). Sources: Justice Department and OIG Statement

Trending Michigan Fraud Topics

Alleged DayCare Fraud in Minnesota

Federal authorities have dramatically increased investigations into suspected fraud at Minnesota childcare centers, many of which serve the Somali-American community. DHS Secretary Kristi Noem and FBI Director Kash Patel announced a surge of federal agents after a viral video claimed Somali-operated daycares were diverting millions in federal aid. In the days since, DHS agents were filmed “going inside” dozens of facilities to interview staff, and the Department of Health and Human Services froze all Minnesota childcare payments amid the fraud allegations.

The Justice Department also revealed charges in related schemes – for example, a $14 million kickback fraud in an autism-services program – even as state child welfare regulators say that unannounced inspections of the targeted daycare centers found no evidence of current wrongdoing. The $1 billion in Minnesota taxpayers' money supposedly stolen would exceed the state's entire Department of Corrections budget. Quality Learning Center, which couldn't even spell "learning" right on its door, is receiving $4 million per year.

These actions tie into a much larger Minnesota fraud inquiry: dozens of providers face indictments in scams involving pandemic relief, child nutrition, housing support, and autism therapy programs (about $250 million identified to date). Prosecutors estimate the total losses may exceed $1 billion, and report that the vast majority of those charged are Somali Americans.

Current Status:

PCG is reporting the latest updates as this investigation is ongoing. To date (12/31/2025), no daycare organizations have been arrested, charged, or found guilty of fraud. As this story develops, PCG will update this article accordingly.

Sources: Komo News,

Summary on Michigan Fraud

Michigan is experiencing a sharp escalation in healthcare fraud, with recent federal and state enforcement actions exposing widespread abuse across pharmacies, pain clinics, telemedicine, DME, behavioral health, and publicly funded care programs. From opioid pill mills and phantom pharmacy billing to sham telehealth orders and fabricated counseling services, these schemes reveal how quickly weak controls, high-volume billing, and inadequate oversight can be exploited. The cases outlined in this article highlight recurring fraud patterns, the scale of financial losses to Medicare and Medicaid, and the growing focus of DOJ and OIG investigators on Michigan providers, underscoring the urgent need for stronger auditing, data transparency, and proactive fraud prevention.