Massive Medical Equipment Fraud Leads to $97M in Losses to Medicare

NJ court indicts Florida man for a kickback scheme involving durable medical equipment (DME) that led to a staggering $97 million in losses to Medicare.

NEWARK, NJ – In a significant blow to fraudulent healthcare schemes, Raheel Naviwala, a 35-year-old resident of Coral Springs, Florida, has been indicted for orchestrating a kickback scheme involving durable medical equipment (DME) that led to a staggering $97 million in losses to Medicare. Attorney for the United States, Vikas Khanna, unveiled the indictment today, marking a critical step in the fight against healthcare fraud.

The indictment charges Naviwala with a total of 10 counts, including one count of conspiracy to commit health care fraud and wire fraud, three counts of health care fraud, two counts of wire fraud, one count of conspiracy to violate the federal Anti-Kickback Statute, and three counts of receiving illegal kickbacks. This intricate operation involved multiple call centers and telemedicine companies, which were used to procure doctors’ orders for orthotic braces without any medical necessity, solely for the purpose of defrauding Medicare.

Naviwala and his associates reportedly exploited marketing call centers and telemedicine services to acquire the DME orders, offering bribes ranging from $125 to $450 per brace to certain companies. This elaborate scheme not only inflicted losses exceeding $97 million on Medicare but also resulted in Naviwala and his co-conspirators amassing over $46 million in kickbacks, highlighting the vast scale of the fraud.

The charges laid out carry severe penalties, with conspiracy to commit health care fraud and wire fraud potentially resulting in up to 20 years in prison. The health care fraud and illegal kickbacks counts could lead to 10 years for each count, and the conspiracy to violate the federal Anti-Kickback Statute may result in a maximum of five years in prison. Additionally, each count could entail significant fines, underscoring the gravity of the offenses.

The indictment is the culmination of a meticulous investigation by the FBI, the Department of Health and Human Services-Office of Inspector General, the U.S. Department of Defense, Office of the Inspector General, Defense Criminal Investigative Service, and the U.S. Department of Veterans Affairs Office of Inspector General. The collaborative effort of these agencies underlines the commitment of federal law enforcement to dismantling fraudulent schemes that exploit the healthcare system.

Assistant U.S. Attorneys Matthew Specht and Ray Mateo of the Opioid Abuse Prevention & Enforcement Unit in Newark represent the government in this case. While the indictment brings to light the accusations against Naviwala, it is important to remember that he remains presumed innocent until proven guilty. This case serves as a stark reminder of the ongoing battle against healthcare fraud and the dedication of law enforcement to protect the integrity of Medicare and other vital programs.