NEWARK, N.J. — Raheel Naviwala, 36, of Coral Springs, Florida, was convicted by a federal jury for his role in a fraudulent durable medical equipment (DME) scheme that defrauded Medicare and other insurers of millions. The U.S. Attorney’s Office for the District of New Jersey announced the conviction on March 6.
On February 28, Naviwala was found guilty of conspiracy to commit health care fraud and wire fraud, as well as violating the Anti-Kickback Statute. He was involved in a scheme where he and his coconspirators illegally obtained Medicare patient information and used telemarketers to convince patients to obtain medically unnecessary DME, such as orthotic braces.
The telemarketers would pre-fill prescriptions for high-reimbursement braces and send them to telemedicine doctors for approval. These doctors, often without speaking to patients, signed the prescriptions, which Naviwala then sold to DME supply companies. These companies would bill Medicare, TRICARE, and other insurers for the products.
To cover up the scheme, Naviwala and his co-conspirators created sham contracts and invoices, falsely claiming that he provided marketing or consulting services. Naviwala also owned a DME supply company that submitted fraudulent claims to Medicare, sometimes for up to nine braces per patient.
According to the U.S. Attorney’s Office, Medicare and other insurers paid at least $100 million for the DME linked to Naviwala’s companies, and the conspiracy reaped hundreds of millions in total. Naviwala personally pocketed more than $10 million from the scheme.
U.S. Attorney John Giordano emphasized that this conviction shows the serious consequences for those who seek to exploit the medical system for personal gain, stating, “When people siphon millions from Medicare to line their own pockets, regular citizens pay the price.”
