National Health Care Fraud Takedown results in 324 defendants charged in connection with over $14.6 billion in alleged fraud

BUFFALO, NY , Today, United States Attorney Michael DiGiacomo announced criminal charges were brought against Dr. Joel Durinka, and a civil action was filed against Dr. Enaame Farrell in connection with alleged schemes to defraud Medicare.

Both matters involved prescribing durable medical equipment (DME) that were not medically necessary. Their conduct resulted in Medicare paying millions of dollars for DME that were not medically necessary. The two matters are part of the Department of Justice’s 2025 National Health Care Fraud Takedown.

“This record-setting Health Care Fraud Takedown delivers justice to criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers,” said Attorney General Pamela Bondi. “Make no mistake to this administration will not tolerate criminals who line their pockets with taxpayer dollars while endangering the health and safety of our communities.” Fraud, waste and abuse targeting Medicare impacts all taxpayers who fund the program,” stated U.S. Attorney DiGiacomo.

“This office will not hesitate to pursue those who defraud government programs funded by taxpayer dollars.” Joel Durinka, 40, of Orchard Park, NY, was charged by indictment with conspiracy to commit health care fraud, health care fraud, and false statements relating to health care matters in connection with a telehealth/durable medical equipment (“DME”) scheme. As alleged in the indictment, Durinka, a medical doctor, billed Medicare for audio-only telehealth visits that were either brief or did not occur at all. Durinka billed Medicare approximately $5.6 million for these fraudulent telehealth visits.

It was also part of the scheme that, for the same beneficiaries, Durinka produced and maintained false and fictitious medical records and fraudulently certified orders for braces without regard to the braces’ medical necessity. Durinka billed Medicare approximately $29.6 million for these fraudulent DME orders. The government has seized $325,683.07 in money from Durinka.

The case is being prosecuted by Assistant U.S. Attorneys Evan Glaberson and David M. Coriell of the U.S.

Attorney’s Office for the Western District of New York. Enaame Farrell, 50, of Niagara Falls, Ontario, Canada, was subject to a civil complaint alleging violations of the False Claims Act, as well as other common law causes of action, in connection with scheme to defraud Medicare by causing the submission of false and fraudulent claims for which Medicare paid approximately $3.4 million. As alleged in the complaint, Farrell, a licensed medical doctor, ordered items and services, including durable medical equipment, for Medicare beneficiaries without speaking with or examining the beneficiaries, signing pre-populated order forms within seconds of accessing the beneficiaries’ medical records.

The case is being prosecuted by Assistant U.S. Attorney David M. Coriell of the U.S.

Attorney’s Office for the Western District of New York. The Justice Department today announced the results of its 2025 takedown, which resulted in criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals, in 50 federal districts and 12 State Attorneys General’s Offices across the United States, for their alleged participation in various health care fraud schemes involving over $14.6 billion in intended loss. The Takedown involved federal and state law enforcement agencies across the country and represents an unprecedented effort to combat health care fraud schemes that exploit patients and taxpayers.

Demonstrating the significant return on investment that results from health care fraud enforcement efforts, the government seized over $245 million in cash, luxury vehicles, cryptocurrency, and other assets as part of the coordinated enforcement efforts. As part of the whole-of-government approach to combating health care fraud announced today, the Centers for Medicare and Medicaid Services (CMS) also announced that it successfully prevented over $4 billion from being paid in response to false and fraudulent claims and that it suspended or revoked the billing privileges of 205 providers in the months leading up to the Takedown. Civil charges against 20 defendants for $14.2 million in alleged fraud, as well as civil settlements with 106 defendants totaling $34.3 million, were also announced as part of the Takedown.

Today’s Takedown was led and coordinated by the Health Care Fraud Unit of the Department of Justice Criminal Division’s Fraud Section and its core partners from U.S. Attorneys’ Offices, the Department of Health and Human Services Office of Inspector General (HHS-OIG), the Federal Bureau of Investigation (FBI), and the Drug Enforcement Administration (DEA). The cases were investigated by agents from HHS-OIG, FBI, DEA, and other federal and state law enforcement agencies.

The cases are being prosecuted by Health Care Fraud Strike Force teams from the Criminal Division’s Fraud Section, 50 U.S. Attorneys’ Offices nationwide, and 12 State Attorneys General Offices. “As part of making healthcare accessible and affordable to all Americans, HHS will aggressively work with our law enforcement partners to eliminate the pervasive health care fraud that bedeviled this agency under the former administration and drove up costs,” said Secretary Robert F.

Kennedy Jr. of the Department of Health and Human Services. “The Criminal Division is intensely committed to rooting out health care fraud schemes and prosecuting the criminals who perpetrate them because these schemes: (1) often result in physical patient harm through medically unnecessary treatments or failure to provide the correct treatments; (2) contribute to our nationwide opioid epidemic and exacerbate controlled substance addiction; and (3) do all of that while stealing money hardworking Americans contribute to pay for the care of their elders and other vulnerable citizens,” said Matthew R. Galeotti, Head of the Justice Department’s Criminal Division.

“The Division’s Health Care Fraud Unit and U.S. Attorneys’ Offices stand united with our law enforcement partners in this fight, and we will continue to use every tool at our disposal to protect the integrity of our health care programs for the American people.” “Health care fraud drains critical resources from programs intended to help people who truly need medical care,” said Director Kash Patel of the FBI. “Today’s announcement demonstrates our commitment to pursuing those who exploit the system for personal gain.

With more than $13 billion in fraud uncovered, this is the largest takedown for this initiative to date. Together, the FBI and our law enforcement partners will continue to hold those accountable who steal from the American people and undermine our health care systems.” Transnational Criminal Organizations 29 defendants were charged for their roles in transnational criminal organizations alleged to have submitted over $12 billion in fraudulent claims to America’s health insurance programs. For instance, a nationwide investigation known as Operation Gold Rush resulted in the largest loss amount ever charged in a health care fraud case brought by the Department.

These charges were announced in the Eastern District of New York, the Northern District of Illinois, the Central District of California, the Middle District of Florida, and the District of New Jersey against 19 defendants. Twelve of these defendants have been arrested, including four defendants who were apprehended in Estonia as a result of international cooperation with Estonian law enforcement and seven defendants who were arrested at U.S. airports and the U.S. border with Mexico, cutting off their intended escape routes as they attempted to avoid capture. The organization allegedly used a network of foreign straw owners, including individuals sent into the United States from abroad, who, acting at the direction of others using encrypted messaging and assumed identities from overseas, strategically bought dozens of medical supply companies located across the United States.

They then rapidly submitted $10.6 billion in fraudulent health care claims to Medicare for urinary catheters and other durable medical equipment by exploiting the stolen identities of over one million Americans spanning all 50 states and using their confidential medical information to submit the fraudulent claims. As alleged, the organization exploited the U.S. financial system by laundering the fraudulent proceeds and deploying a range of tactics to circumvent anti-money laundering controls to transfer funds into cryptocurrency and shell companies located abroad. The arrests announced today also include a banker who facilitated the money laundering of fraud proceeds on behalf of the organization through a U.S.-based bank.

The Health Care Fraud Unit’s Data Analytics Team and its partners detected the anomalous billing through proactive data analytics, and HHS-OIG and CMS successfully prevented the organization from receiving all but approximately $41 million of the approximately $4.45 billion that was scheduled to be paid by Medicare. HHS and CMS intend to seek to return the $4.41 billion in escrow to the Medicare trust fund for needed medical care. The scheme nonetheless resulted in payments of approximately $900 million from Medicare supplemental insurers.

To date, law enforcement has seized approximately $27.7 million in fraud proceeds as part of Operation Gold Rush. In another action involving foreign influence, charges were filed in the Northern District of Illinois against five defendants, including two owners and executives of Pakistani marketing organizations, in connection with a $703 million scheme in which Medicare beneficiaries’ identification numbers and other confidential health information were allegedly obtained through theft and deceptive marketing. The defendants allegedly used artificial intelligence to create fake recordings of Medicare beneficiaries purportedly consenting to receive certain products.

According to court documents, the beneficiaries’ confidential information was then illegally sold to laboratories and durable medical equipment companies, which used this unlawfully obtained and fraudulently generated data to submit false claims to Medicare. Certain defendants controlled dozens of nominee-owned durable medical equipment companies and laboratories that allegedly submitted fraudulent claims for products and services the beneficiaries did not request, need, or receive. Certain defendants also allegedly conspired to conceal and launder the fraud proceeds from bank accounts they controlled in the United States to bank accounts overseas.

In total, the defendants caused approximately $703 million in alleged fraudulent claims to Medicare and Medicare Advantage plans, which paid approximately $418 million on those claims. The government seized approximately $44.7 million from various bank accounts related to this case. Finally, a defendant based in Pakistan and the United Arab Emirates who owned a billing company allegedly orchestrated a scheme to prey upon vulnerable individuals in need of addiction treatment by conspiring with treatment center owners to fraudulently bill Arizona Medicaid approximately $650 million for substance abuse treatment services.

According to court documents, some of the services billed were never provided, while other services were provided at a level that was so substandard that it failed to serve any treatment purpose. As part of the conspiracy, treatment center owners allegedly paid illegal kickbacks in exchange for the referral of patients recruited from the homeless population and Native American reservations. The defendant received at least $25 million of ill-gotten Arizona Medicaid funds as a result of the conspiracy and is charged with a money laundering offense for his alleged use of those funds to purchase a $2.9 million home located on a golf estate in Dubai.

Fraudulent Wound Care Charges were filed in the District of Arizona and the District of Nevada against seven defendants, including five medical professionals, in connection with approximately $1.1 billion in fraudulent claims to Medicare and other health care benefit programs for amniotic wound allografts. As alleged, certain defendants targeted vulnerable elderly patients, many of whom were receiving hospice care, and applied medically unnecessary amniotic allografts to these patients’ wounds. Many of the allografts allegedly were applied without coordination with the patients’ treating physicians, without proper treatment for infection, to superficial wounds that did not need this treatment, and to areas that far exceeded the size of the wound.

Certain defendants allegedly received millions in illegal kickbacks from the fraudulent billing scheme. “Today's unprecedented enforcement action demonstrates that CMS and our federal partners are united in our mission to protect the integrity of Medicare and Medicaid by crushing waste, fraud, and abuse," said Administrator Dr. Mehmet Oz of CMS.

"Every dollar we prevent from going to fraudsters is a dollar that stays in the system to serve legitimate beneficiaries. Through advanced data analytics, real-time monitoring, and swift administrative action, CMS is leading the fight to protect Medicare, Medicaid, and the trust Americans place in these vital programs. We're not waiting for fraud to happen, we're stopping it before it starts." Prescription Opioid Trafficking 74 defendants, including 44 licensed medical professionals, were charged across 58 cases in connection with the alleged illegal diversion of over 15 million pills of prescription opioids and other controlled substances.

For example, five defendants associated with one Texas pharmacy were charged with the unlawful distribution of over 3 million opioid pills. As alleged, the defendants conspired to distribute