In the largest health care fraud operation of its kind, the U.S. Department of Justice (DOJ) has charged 324 defendants in connection with over $14.6 billion in fraudulent Medicare claims, part of the 2025 National Health Care Fraud Takedown.
Key charges in New York
Two medical professionals in Western New York are at the center of local allegations:
- Dr. Joel Durinka, Orchard Park: Accused of billing Medicare $5.6 million for fake telehealth visits and an additional $29.6 million for unnecessary durable medical equipment (DME) orders. Durinka also allegedly falsified medical records and has had over $325,000 seized by the government.
- Dr. Enaame Farrell, Niagara Falls, Ontario: The subject of a civil complaint alleging $3.4 million in Medicare fraud for ordering DME without patient interaction or medical necessity.
“These schemes steal from taxpayers and endanger patient safety,” said U.S. Attorney Michael DiGiacomo. “We will not hesitate to pursue fraudsters exploiting Medicare.”
A nationwide sweep
The DOJ’s takedown spans 50 federal districts and 12 state AG offices, involving:
- 96 medical professionals including doctors, nurse practitioners, and pharmacists
- Over $245 million in seized assets including cash, crypto, and luxury goods
- 205 providers suspended or revoked by CMS
- $4 billion in fraudulent claims prevented through advanced analytics
International fraud rings
A major focus was Operation Gold Rush, which uncovered a $10.6 billion fraud scheme exploiting the stolen identities of over 1 million Americans. The scheme was orchestrated by foreign nationals using shell companies and encrypted messaging to submit false claims for urinary catheters and other DME. Only $41 million was paid before intervention.
Other schemes included:
- AI-generated fake Medicare consent recordings
- Billing dead patients
- Targeting Native American communities and the homeless
- Kickback-laced opioid trafficking
Enforcement and next steps
The DOJ, FBI, DEA, HHS-OIG, and CMS are now creating a Health Care Fraud Data Fusion Center to centralize fraud detection using AI and cloud computing. CMS also recovered billions by suspending suspicious claims and providers.
“Every dollar stolen is a dollar lost to real care,” said CMS Administrator Dr. Mehmet Oz. “This is about preserving Medicare for those who depend on it.”
This content is brought to you by the FingerLakes1.com Team. Support our mission by visiting www.patreon.com/fl1 or learn how you send us your local content here.