A Florida man was convicted by a federal jury for his role in a durable medical equipment (DME) kickback scheme that caused millions of dollars in losses to Medicare and other insurance providers. Following a month-long jury trial, Raheel Naviwala, 36, of Coral Springs, Florida, was convicted of conspiracy to commit healthcare fraud and wire fraud, one count of healthcare fraud, conspiracy to violate the Anti-Kickback Statute, and three counts of violating the Anti-Kickback Statute. He was also acquitted of two counts of healthcare fraud. Naviwala and his coconspirators purchased lists of Medicare patients’ names, addresses, and phone numbers, and hired telemarketers to convince the patients to get DME (orthotic braces). These telemarketers pre-filled prescriptions and picked the highest-paying braces to bill to insurers. Naviwala then paid telemedicine doctors to sign the pre-filled prescriptions for braces, regardless of whether the patients needed or wanted braces. Generally, the telemedicine doctor did not even speak to the patients before signing the pre-filled prescriptions.
Naviwala then sold the signed prescriptions to DME supply companies that could bill Medicare, TRICARE, and other insurers for the braces. To conceal the fraud, Naviwala and his coconspirators signed sham contracts and used sham invoices that falsely represented that Naviwala was billing DME supply companies for marketing or consulting. Naviwala also owned and operated a DME supply company that was used to bill Medicare, and which submitted claims to Medicare for up to nine braces for a single patient. To further conceal his illegal conduct, Naviwala put multiple of his businesses in the names of nominee owners. The nominee owners generally performed no legitimate work for any company and were paid to hide Naviwala’s involvement. Medicare and other insurers paid hundreds of millions of dollars to members of the conspiracy and paid at least approximately $100 million for DME associated with Naviwala’s companies. Naviwala personally pocketed more than $10 million in fraud proceeds.
