Nevada Doctor Charged with $95M Wound Care Fraud on Medicare

National Fraud Enforcement Division’s first announced charges in Nevada since the formation of the West Coast Health Care Fraud Strike Force

A federal grand jury in the District of Nevada returned an indictment yesterday charging Stephen Dubin, M.D., 74, of Henderson, Nevada, with a $95 million scheme to defraud Medicare by billing for medically unnecessary amniotic wound allografts that he and others applied to elderly Medicare patients.

“This indictment exposes a scheme driven by greed, not medicine. As alleged, this provider exploited elderly patients by pushing costly and unnecessary medical procedures, then lied to Medicare to pocket millions of taxpayer dollars,” said Assistant Attorney General Colin M. McDonald of the Justice Department’s National Fraud Enforcement Division. “Schemes like this drain Medicare of resources and impose substantial burdens on the taxpayers who fund it. Let this serve as a warning: any healthcare professional who tries to get rich at the expense of patient care can expect to face the same scrutiny — and the same consequences.”

“Healthcare fraud is not a victimless crime; it steals vital resources from elderly and vulnerable citizens who truly need life-saving treatments,” said First Assistant U.S. Attorney Sigal Chattah for the District of Nevada. “These defendants prioritized personal greed over patient care by weaponizing complex billing codes for advanced wound care products. As part of the West Coast Health Care Strike Force, our office, alongside our federal law enforcement partners, will continue to aggressively dismantle predatory schemes that target public healthcare programs.”

“Dr. Duben, as a physician, had a duty to prioritize the well-being of his patients; however, he engaged in unethical practices by prescribing costly, unnecessary allografts at taxpayer expense,” said Special Agent in Charge Christopher S. Delzotto of the FBI Las Vegas Field Office. “This betrayal of trust and exploitation of his healthcare position for personal financial gain is both cruel and premeditated. The FBI remains dedicated to collaborating with federal, state, and local agencies to investigate individuals like Dr. Duben and to safeguard federally funded healthcare programs from provider abuse.”

“These charges reflect a clear and calculated betrayal of elderly Medicare patients who depend on trusted providers for legitimate care,” said Special Agent in Charge Robb R. Breeden of the U.S. Department of Health and Human Services Office of Inspector General (HHS‑OIG). “Schemes like this siphon taxpayer dollars, undermine patient safety, and erode confidence in our health care system. HHS‑OIG, working closely with our law enforcement partners, will continue to identify and hold accountable those who exploit federally funded health care programs for personal gain.”

“Fraud involving TRICARE, the healthcare program that provides medical coverage for active duty service members, retirees, and their families, strikes at a benefit earned through service to our nation,” said Special Agent in Charge John Helsing of the Defense Criminal Investigative Service’s Western Field Office. “As the criminal investigative arm of the Department of Defense’s Office of Inspector General, DCIS is steadfast in protecting TRICARE from individuals who manipulate medical billing for personal gain. The West Coast Health Care Fraud Task Force, working with our federal partners, greatly enhances our ability to detect and dismantle these schemes, ensuring we preserve the integrity of our nation’s military health system.”

According to court documents, Dubin, a medical doctor and sole owner of Dubin Medical Consultants, Inc. (also known as Wound MD) caused Medicare to be billed over $95 million for expensive amniotic allografts that he procured through illegal kickbacks and bribes. Dubin allegedly applied these allografts to elderly patients — including vulnerable patients in hospice care — without medical necessity. Medicare paid over $54 million based on Dubin’s false and fraudulent claims.

As alleged in the indictment, Dubin received illegal kickbacks, bribes, and rebates from two different allograft distributors. Some of these illegal payments were falsely structured to appear as legitimate “Rebate Agreements” while concealing their true nature and illegal payments. These purported rebates substantially reduced Dubin’s true net cost of acquiring the allografts. Dubin allegedly submitted claims to Medicare seeking reimbursement for the price listed on sham full-price invoices, instead of the actual price he paid for the allografts. Dubin and others allegedly kept as profit the difference between Medicare’s reimbursement and the price paid for the allografts.

The indictment also alleges that Dubin received illegal kickbacks from one allograft distributor through payments from a pass-through bank account held in the name of a shell company in exchange for purchasing allografts from the distributor.

Induced by these illegal kickbacks, bribes, and rebates, Dubin and his co-conspirators applied allografts without regard to medical necessity, including by applying allografts to infected wounds; to wounds that were not responding to allograft treatment; without first attempting, completing, or confirming conservative wound care treatment as required by Medicare; and in quantities that far exceeded the size of wounds. Dubin allegedly selected allografts that would maximize his profit, not based on the patient’s need. To conceal the lack of medical necessity, Dubin falsified patient medical records to make it appear as though the application of allografts was medically reasonable and met Medicare requirements.

Dubin used the proceeds of his alleged offenses to fund a lavish lifestyle, including having multi-million-dollar yachts built for him.

Dubin is charged with conspiracy to commit health care fraud and five counts of health care fraud. If convicted, he faces a maximum penalty of 10 years in prison for each count.

FBI, HHS-OIG, and DCIS are investigating the case.

Trial Attorneys Chris Wenger and Shane Butland of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Jessica Oliva for the District of Nevada are prosecuting the case.

On April 7, the Department of Justice announced the creation of the National Fraud Enforcement Division (Fraud Division). The Fraud Division is laser-focused on investigating and prosecuting those who commit fraud against the American people. The Department’s work to combat fraud support President Trump’s Task Force to Eliminate Fraud, a whole-of-government effort chaired by Vice President J.D. Vance to eliminate fraud, waste, and abuse within Federal benefit programs.

On April 30, the Fraud Division announced the formation of the West Coast Health Care Fraud Strike Force, a multi-district enforcement initiative uniting the Division’s Health Care Fraud Section with the U.S. Attorney’s Offices for the District of Arizona, District of Nevada, and Northern District of California.

The Department of Justice’s Health Care Fraud Strike Force Program, currently comprised of nine strike forces operating in federal districts across the country, has charged more than 6,200 defendants who collectively billed federal health care programs and private insurers more than $45 billion since 2007. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.

A body shop owner is accused of submitting false insurance claims to Geico as proof that he purchased a new part for a vehicle in his shop, according to the Florida Department of Financial Services.

FDFC says that Devin Michael Simmons, 38, who is the owner of Exotic Solutions in Delray Beach, was investigated after Geico alleged the false documentation stemming from a 2024 claim for vehicle repair.

The affidavit says that on December 3, 2024, Geico approved and issued a two-party payment totaling $14,086.25, including payment for an OEM hood for a damaged 2012 Mercedes-Benz.

However, a Geico adjuster later discovered that a cheaper aftermarket hood had been installed on the damaged Mercedes-Benz. Then, when Geico requested proof of the OEM hood purchase, Simmons submitted an invoice from Mercedes-Benz of Delray that was determined to be fabricated, per the affidavit.

Investigators then went on to say that Simmons acknowledged that the OEM hood was never ordered nor installed, and Geico sought reimbursement for the roughly $3,900 difference between the OEM hood, and the cheaper aftermarket part.

Today, San Francisco District Attorney Brooke Jenkins announced that Declan McKevitt (47) and Grace McKevitt (54) of San Francisco were arraigned on multiple felony charges of workers compensation premium fraud and payroll tax fraud in connection to a scheme to deny the claim of an injured worker. Mr. and Ms. McKevitt each pleaded not guilty to all charges and denied the allegations.

Mr. and Ms. McKevitt are each charged with insurance fraud (IC 11880(a)), failure to make contributions (UIC 2108), acting to evade tax (UIC 2117.5), and failure to collect or pay over tax or other money (UIC 2118.5).

In addition, Mr. McKevitt is also charged with two counts of insurance fraud (IC 1871.4(a)(1)) for making a false and fraudulent statement to deny compensation and for discouraging an injured worker from claiming benefits or pursuing a workers compensation claim.

Bail in the amount of $40,000 was set for both Mr. and Ms. McKevitt. Each posted bail and was subsequently released on their own recognizance. Both are scheduled to be back in court on October 15, 2026, at 9:00 am in Department 9 at the Hall of Justice.

According to court records, Mr. and Ms. McKevitt own and manage a construction business, An Dun Construction. Allegedly, Mr. and Ms. McKevitt fraudulently underreported their payroll to their workers compensation insurance company and to the California Employment Development Department and failed to pay insurance premiums, income tax, payroll tax, and other legally required contributions.

This premium fraud and payroll tax fraud was discovered after an employee severely injured his hand on a table saw, resulting in an amputated finger. Allegedly, Mr. McKevitt told the injured worker to deny that the injury was work-related while seeking medical care. Allegedly, he further denied that this injured worker was employed by An Dun Construction and claimed that the worker was at the jobsite without his knowledge. This false denial of employment caused a four-month delay in payment of benefits owed to the injured worker. Payroll records and witness statements showed that this injured worker was employed by An Dun Construction for about seven months before the injury.

This case was investigated and charged by the Economic Crimes Unit of the San Francisco District Attorney’s Office.

Although charges have been filed, the District Attorney’s Economic Crimes Unit continues to investigate this matter along with other pending criminal investigations. Anyone with information is asked to call the San Francisco District Attorney’s Office’s Economic Crimes Unit Tip Line at 1-628-652-4444. You may remain anonymous.

Authorities have added four more insurance fraud charges to those already lodged against an city official in coastal Alabama.

Prichard City Councilman Derrick Griffin last week was indicted by a grand jury for the second time in four months. In December, he was charged with making fraudulent representations on the purchase of a BMW automobile.

On Thursday, the grand jury said he also misrepresented to insurance companies his ownership of an Acura, a Ford van, another BMW and a Nissan Frontier, according to local news reports.

The charges, if they result in a conviction, carry a maximum sentence of 20 years in prison, authorities said.

Investigators say a Metro Detroit duo has been tied to hundreds of suspected bogus jobless claims across 32 states totaling over $4 million. And when things went sideways, investigators say a series of texts between the two captured the moment the alleged scheme hit panic mode.

Shawn Carter, 38, of Woodhaven, and Danielle Thomas, 36, are now charged with conspiracy to commit wire fraud and aggravated identity theft, according to a special agent with the U.S. Department of Labor’s Office of Inspector General.

How the feds say it started

Federal investigators say it started with online unemployment insurance (UI) claims, filed fast, in bulk, and sometimes in other people’s names, then turned into money on Bank of America debit cards that could be drained at ATMs.

In a criminal complaint filed Aug. 1, 2026, in federal court, the U.S. Department of Labor special agent working out of Detroit described how unemployment benefits are commonly paid — often by debit cards issued by Bank of America and mailed through the U.S. Postal Service.

The feds said electronic transfers are moved through data centers in Virginia and Colorado, which is why the movement of those funds can be framed as interstate wire communications.

Investigators said the alleged fraud took advantage of the massive pandemic-era expansion of unemployment benefits from March 2020 through Sept. 4, 2021, when federal programs pumped large supplemental funds to states.

Digital and financial footprints lead to Detroit

Investigators said they determined Carter and Thomas were associated with hundreds of suspected fraudulent claims between March 15, 2020, and March 10, 2022. The digital and financial fingerprints included common IP and email addresses, bank accounts, home addresses and “similarities in claim information.”

For Carter, agents said they identified at least 68 suspected fraudulent UI claims filed in his name using his Social Security number and the Social Security numbers of other people.

For Thomas, investigators said they identified at least 25 suspected fraudulent UI claims filed in her name using her Social Security number and the Social Security numbers of others, plus an additional 26 suspected claims tied to her home address.

Debit cards and ATM images of cash withdrawals

The feds said the fraudulent claims generated debit cards that were mailed to Michigan addresses, then used to withdraw cash in metro Detroit.

In one California claim tied to Detroit, a Bank of America unemployment debit card was allegedly mailed there, and $20,100 in benefits was deposited into the debit account.

Bank of America handed over ATM surveillance photos of a withdrawal made with that card on Aug. 25, 2020, which, according to federal investigators, showed Carter as the person in the images. They also said they linked a gold necklace Carter was wearing to an image on Carter’s phone.

In multiple instances, the complaint said, Bank of America debit cards were mailed to Detroit addresses and then used in cash withdrawals in Michigan, and investigators determined Carter was the person on surveillance images making those withdrawals.
In another case, a California claim was listed at a Detroit address, and $20,400 was deposited on July 23, 2020. But investigators said the person whose name was on the claim was later interviewed, and they said they did not receive benefits and did not give anyone permission.

The feds also said another “Shawn Carter” — a victim — was interviewed, too. A Hawaii claim filed Nov. 18, 2020, allegedly used the Social Security number of another man named Shawn Carter, and that an image of a Hawaii claim in his name was found on Thomas’ phone. The feds said they later interviewed the victim, Shawn Carter, on July 8, 2024, and he said he was a victim of identity theft and that he did not file any claim.

The Dearborn arrest and what police say they found

On Oct. 12, 2021, Dearborn police were dispatched to the Dearborn Federal Credit Union after a report of “a fraud in progress,” according to the complaint.

A woman, later identified as Danielle Thomas, was apparently using a fraudulent credit card to withdraw money. When officers arrived and asked for ID, the feds said Thomas gave them “a counterfeit Pennsylvania Driver’s License.” They said the name on the ID was real, but it had Thomas’ photo on it.

Police arrested Thomas for fraud and obstruction of justice, and during the arrest, officers said they discovered multiple fake driver’s licenses with Thomas’ picture on them. They said they also found several California UI debit cards in names of other people — including one matching the name on the counterfeit Pennsylvania license.

Police said they also took Thomas’ phone. After a search, police said they found notes and images with personal identifying information, claim information, email accounts tied to claims, and conversations about unemployment fraud — including conversations between Thomas and Carter.

The texts: ‘Delete all your messages’

The complaint included text message exchanges investigators say show the two coordinating debit cards and withdrawals.

On Oct. 5, 2021, the feds said Thomas, and a phone number registered to Carter, exchanged messages that appeared to be about a Bank of America unemployment debit card tied to a claim:

  • CARTER: “You at home need that T.L. [name redacted] card”
  • THOMAS: “Yeah I’m home”
  • CARTER: “Ok”
  • CARTER: “The one you got ain’t locked is it”
  • THOMAS: “idk”
  • CARTER: “Send me the back of the card on telegram so I can check”
  • THOMAS: “Ok”

Then came the messages from Oct. 12, 2021 — just prior and leading up to Thomas’ arrest, the feds said. It allegedly starts as Carter tells her he’s headed to Detroit:

  • CARTER: “On my way to the city”
  • THOMAS: “Ok”
  • CARTER: “Meet me at shop”
  • THOMAS: “Ok”
  • CARTER: “Bring the M [name redacted] one”
  • THOMAS: “Ok”

Then, as the two allegedly discuss which banks work, the messages get more specific:

  • THOMAS: “It just decline”
  • CARTER: “I just activated the one at my mom house this the card that work they sent two”
  • THOMAS: “Chase Ford rd”
  • CARTER: “Before Telegraph”
  • THOMAS: “Yeah”
  • CARTER: “Meet me at the boa right there”

A few lines later:

  • THOMAS: “It’s good I only could do 5k”
  • CARTER: “Ok bet chase should be good now”
  • THOMAS: “It DC in chase but it worked in dfcu”
  • CARTER: “Ok so dfcu and tcf it out”

And then, abruptly:

  • THOMAS: “The police here”
  • CARTER: “Huh”
  • CARTER: “On my way”
  • THOMAS: “They going through my car but I’m in the police car”
  • CARTER: “What was all in there”
  • THOMAS: “Cards money ids”
  • CARTER: “Is they gon give me your car”
  • CARTER: “Can you call”
  • THOMAS: “No I’m sneaking texting you I’m handcuffed”
  • CARTER: “Delete all your messages”
  • THOMAS: “OK”

A separate search at Carter’s home

The feds said they later searched Carter’s Woodhaven home on July 13, 2023, with the help of Northville Township police (under a state warrant tied to bank fraud and check fraud). They said Carter was there when they arrived. Police said they seized “dozens of fake ID cards, banking documents associated with fraudulent accounts, cashier’s checks and counterfeit social security cards,” along with electronic devices later searched under a federal warrant for evidence of unemployment fraud.

The exact dollar figure

In total, the feds said, “approximately $4,117,788 in UI benefits were disbursed on claims associated with the duo.

Both Carter and Thomas are scheduled for a preliminary hearing on Aug. 7, 2026, at 1 p.m. in Detroit.

He is wanted by federal prosecutors, named in an indictment, and described by the FBI as “at large.” Yet Brian Sutton, the man US authorities say ran one of the largest healthcare fraud operations ever uncovered in the country, is reportedly cruising around Moscow in a fleet of Mercedes-Benz cars, living in a sprawling villa west of the Russian capital, and holding a stake in a mixed martial arts club with ties to Russia’s ruling party.

For an industry that spent the better part of a decade absorbing the losses from Sutton’s alleged scheme, the news that he has resurfaced in comfortable exile rather than a courtroom is a fresh reminder of just how hard it is to claw back money once a fraud crosses international borders.

Nearly $2 billion in fraudulent prescriptions

According to the US Department of Justice, the operation ran from 2017 to 2022 and worked like this: call centers, first based in Utah and later relocated to Russia, cold-called people covered by private health plans and offered them medication at no cost, often without any genuine medical review. Regardless of whether the person agreed to anything, the group generated a prescription anyway, attaching the name and national provider number of a real physician who had no idea a “visit” had taken place. Dozens of pharmacies bought up through straw owners across states including New York, New Jersey, Pennsylvania, Texas and Alabama then billed the claims through to private insurers.

The numbers are eye-watering. The DOJ says the group submitted more than $1.97 billion in fraudulent claims, and insurers actually paid out over $758 million before the scheme was unwound. A related, earlier case in California — dating back to 2015 and centred on a separate network of pharmacies prosecutors nicknamed “mutant pharmacies” for being stocked more like fraud mills than dispensaries — added tens of millions more to the total, according to reporting by the investigative outlet OCCRP. Fifteen defendants in that case eventually pleaded guilty.

On the federal side, seven co-defendants have now pleaded guilty or been convicted, with recent sentences of up to ten years and forfeiture orders running into the millions. But Sutton, the man prosecutors say directed the whole operation, was never in the room for any of it.

A villa near Putin’s back yard

OCCRP’s investigation, carried out with its Russian partner Important Stories, traces how Sutton built a new life in Russia after the fraud was exposed. Leaked traffic police records reportedly show he began registering luxury vehicles in Russia as early as 2019, and his collection is said to now include roughly two dozen Mercedes-Benz cars alongside BMWs and Rolls-Royces. Land registry filings cited in the investigation show a family member bought a villa in Barvikha 21, an exclusive gated development close to Russian President Vladimir Putin’s Novo-Ogaryovo residence; Sutton is reported to have since bought a second property in the same development and expanded his plot to more than 6,500 square metres.

He has also built a business presence there, according to the reporting, including a Moscow marketing call center and a coal-trading company that once counted major Russian steel producers among its partners, plus a stake in a Chechnya-linked MMA club whose backers include a member of Russia’s parliament.

None of this is likely to change anything for the insurers still owed restitution. As Ilya Shumanov, former head of the Russian branch of Transparency International, told OCCRP, there is no extradition treaty between Washington and Moscow, and cooperation between the two countries’ law enforcement agencies is essentially limited to counterterrorism matters. “The chance of his extradition to the United States is zero,” he said.

Why this matters for carriers

Healthcare fraud tied to telemedicine has been a persistent headache for the industry since usage exploded during the pandemic — Insurance Business reported in 2022 that estimates of annual telehealth-related fraud losses ran as high as $35 billion. The Sutton case is essentially a worst-case illustration of that risk: a scheme sophisticated enough to fabricate entire doctor visits, launder proceeds through shell companies, and ultimately move its leadership beyond the reach of US courts entirely.

It also lands at a moment when fraud detection itself is becoming an arms race. Insurance Business reported earlier this year that the same generative tools insurers hoped would help them catch bad claims are increasingly being used by fraudsters to fabricate records and synthetic identities at scale, with total US healthcare fraud losses estimated at roughly $105 billion a year.

For special investigation units and claims teams, the case is a reminder that the biggest exposure often isn’t the fraud itself, but what happens after it’s caught: money already laundered offshore, defendants already relocated to jurisdictions with no extradition treaty, and restitution orders that may never be collected in full. Whatever is eventually recovered from Sutton’s convicted co-conspirators, insurers are unlikely to see much of the $758 million actually paid out on the scheme.

A Carlisle woman has been arrested on multiple felony charges after an investigation by the Arkansas Attorney General’s Office uncovered the alleged financial exploitation of residents at a Lonoke nursing home.

According to Attorney General Tim Griffin, 45-year-old Traci Wagner was arrested on July 29 and charged with 28 counts of exploitation of an impaired or endangered adult, including 22 Class C felonies and six Class B felonies.

Investigators allege that Wagner, while serving as the business manager at Barnes Healthcare in Lonoke, printed checks from residents’ personal accounts, endorsed the checks, and then cashed them without authorization.

The investigation was conducted by Special Agent Matthew Edwards of the Arkansas Attorney General’s Medicaid Fraud Control Unit (MFCU), with assistance from Twenty-Third Judicial District Prosecuting Attorney Chuck Graham.

Attorney General Griffin said protecting vulnerable Arkansans from financial exploitation while they are receiving care in nursing facilities remains a top priority. He also praised investigators and prosecutors for their work in bringing the case forward.

The Medicaid Fraud Control Unit is responsible for investigating allegations of abuse, neglect and financial exploitation involving Medicaid recipients in long-term care facilities, as well as fraud involving the state’s Medicaid program.

No additional details about the amount of money allegedly taken or the number of victims have been released.

The charges against Wagner are allegations only. She is presumed innocent unless and until proven guilty in a court of law.

A Triad woman faces dozens of charges in connection to false medical insurance claims, according to North Carolina Insurance Commissioner Mike Causey.

Melissa Lynn Mountzoures, 54, of Jonesville, was arrested and charged with:

seven counts of insurance fraud
17 counts of forgery
17 counts of uttering a forged instrument
one count of obtaining property by false pretense
All of the charges are felonies.

Special agents with the North Carolina Department of Insurance Criminal Investigations Division accuse Mountzoures of creating multiple fraudulent receipts for doctors’ visits that did not happen and submitting the false receipts to Blue Cross and Blue Shield of North Carolina for reimbursement.

The offenses happened between Feb. 7, 2019, and Nov. 24, 2025.

The receipts totaled $123,056.27.

Mountzoures turned herself in to the Davie County Sheriff’s Office on July 29 and was released under a $42,000 secured bond.

United States Attorney David Metcalf announced that 12 individuals and an agency have been charged by federal indictment and additional defendants charged by the Pennsylvania Office of Attorney General with health care fraud and other offenses, for allegedly conspiring to defraud the Pennsylvania Medicaid program.

U.S. Attorney Metcalf discussed the cases at a news conference this morning, alongside Assistant Attorney General Colin McDonald of the Department of Justice’s National Fraud Enforcement Division; Pennsylvania Attorney General Dave SundayScott Brady, Executive Director of the White House Task Force to Eliminate Fraud; Dr. Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services; T. March Bell, Department of Health and Human Services Inspector General; Wayne Jacobs, Special Agent in Charge of FBI Philadelphia; Stanley Rutkowski, Assistant Special Agent in Charge of Health and Human Services Office of Inspector General (“HHS-OIG”), Philadelphia Regional Office; Timothy Flaherty, Special Agent in Charge of DEA Philadelphia; and Larry Arrow, Assistant Special Agent in Charge of IRS Criminal Investigation (“IRS-CI”) in Philadelphia.

“The great fraud against the American taxpayer takes many forms,” said U.S. Attorney Metcalf. “It is outrageous and unacceptable that anyone could steal money by billing nonexistent home care services for caregivers who were, in fact, dead, in prison, or trafficking drugs.”

In addition, AAG McDonald announced a significant expansion of the Fraud Division’s Northeast Health Care Fraud Strike Force to Philadelphia, an enforcement initiative uniting the Division’s Health Care Fraud Section with the U.S. Attorney’s Office for the Eastern District of Pennsylvania. The Health Care Strike Force model has proven to be one of the most powerful tools in the federal enforcement arsenal, responsible nationally for the prosecution of over 6,200 defendants who collectively billed federal health care programs and private insurers more than $45 billion.

The Strike Force’s expansion into the Eastern District of Pennsylvania brings enhanced federal resources to a district with an established tradition of strong health care fraud enforcement. The partnership between the Fraud Division and the Eastern District of Pennsylvania will uniquely enable law enforcement to combat criminals who hide behind corporations to commit fraud. Philadelphia and its surrounding areas have vibrant and cutting-edge health care technology and insurance industries, and the Eastern District of Pennsylvania has long been a prime venue for private lawsuits that bring unlawful corporate conduct in the health care industry to the attention of law enforcement.

“Home care funding exists to assist America’s elderly and most vulnerable — not to fund schemes in which aides claim be providing care while incarcerated or vacationing in Miami and Saudi Arabia,” said Assistant Attorney General McDonald. “Today’s charges and the expansion of our Northeast Strike Force into the Eastern District of Pennsylvania send a clear message to fraudsters in the region: the Department of Justice will relentlessly pursue you and use all available tools to protect Medicaid and the programs everyday Americans rely on.”

“The magnitude of home care fraud is shocking and requires the total force of the United States government to solve,” said U.S. Attorney Metcalf. “This is why we are excited to announce the return of the Philadelphia Fraud Strike Force, partner with the National Fraud Enforcement Division, and enhance our alliance with Pennsylvania Attorney General Dave Sunday.”

The Unit’s corporate enforcement efforts align closely with the U.S. Attorney’s Office for the Eastern District of Pennsylvania and its history of successful criminal and civil actions against corporate bad actors operating in the health care industry.

Recently, the Eastern District of Pennsylvania has become the target of fraudsters seeking to take advantage of Medicaid’s home health care funds, which should be devoted to assisting elderly and ill Pennsylvanians to age in place with dignity. Today’s announcement is a result of coordinated and dedicated investigations and prosecutions at the federal and state levels.

***

Three federal cases were the focus of today’s takedown; the first case involves three separate indictments charging a total of eight defendants.

The first indictment charges Joseph Pizzo, 47, and Tiziana Taormina, 52, both of Philadelphia, with conspiracy to commit health care fraud, and multiple counts of health care fraud 

The indictment alleges that, from about July 2023 to April 2024, and about July 2024 to May of this year, Taormina, a personal care aide with “Agency 1,” and Pizzo, a Medicaid recipient, schemed to defraud Medicaid. 

They did so through a series of false and fraudulent clock-ins, for care she purportedly provided to Pizzo — including while he was incarcerated in Bucks County, and while he was working a construction job. In total, the indictment alleges that Taormina and Pizzo’s scheme caused a payout of at least $160,000 in Medicaid claims.

The second indictment in the case charges Donna Romsteadt, 63, Alyssa Cuculino, 27, Louise Israel, 46, and Elexis Cuculino, 51, all of Philadelphia, with a similar conspiracy and health care fraud offenses. 

Alyssa Cuculino is the daughter of Elexis Cuculino and the niece of Donna Romsteadt. Alyssa Cuculino and Israel were the home care aides, employed by “Agency 1,” and Romsteadt and Elexis Cuculino were the Medicaid recipients for whom the aides purportedly provided home care.

Also referenced in the indictment is Medicaid “Recipient #1,” a relative of Romsteadt’s who resided with her. Both Israel and Alyssa Cuculino purportedly provided, and billed for, services to “Recipient #1” for lengthy periods. Israel also sought payment for Romsteadt’s supposed care, and Alyssa billed for care she supposedly provided her mother Elexis.

Again, the indictment alleges no-show billing, with Alyssa Cuculino working at another job, or even hospitalized, during times she claimed that she was providing home care. Israel was, at times, incarcerated while purportedly providing care services. As alleged, Romsteadt and Elexis Cuculino actively assisted in the conspiracy, performing fraudulent clock-ins for Alyssa Cuculino and Israel. In total, these four defendants allegedly caused approximately $445,000 in fraudulent claim payouts.

Finally, the third indictment in this case charges Albert Coccia Jr., 56, and Santino Coccia, 28, both of Philadelphia, with conspiracy to commit health care fraud and multiple counts of health care fraud. Albert Coccia Jr., a Medicaid recipient, is the father of Santino Coccia, a home care aide with “Agency 1.”

The indictment alleges repeated billing for care Santino Coccia supposedly provided to his father, at times when Santino Coccia was actually behind the wheel, making hundreds of trips as a contractor for a national rideshare and food-delivery provider. The indictment alleges that the Coccias conspired to cause fraudulent claims and payouts totaling at least $211,000.

The case involving these indictments was investigated by the FBI and HHS-OIG and is being prosecuted jointly by Trial Attorneys Paul J. Koob and Carla Jordan-Detamore of DOJ’s Health Care Fraud Strike Force and Assistant United States Attorney Paul Shapiro of the Eastern District of Pennsylvania.

***

The second federal case features separate indictments against Sean Murray, 58, and Charles Bowie, 53, both of Philadelphia, who both worked for “Home Care Company 1.”

Murray was indicted on one count of health care fraud and nine counts of wire fraud, arising from an alleged scheme to defraud Medicaid through fraudulent home care services. He is already awaiting trial in the Eastern District of Pennsylvania for separate narcotics trafficking and firearms charges.

The indictment alleges that most of what Murray billed for home care services occurred while he was actually at the gym, massage parlor, traveling, or even selling illegal drugs, with Murray paying kickbacks to clients to go along with the scheme. The indictment alleges $400,000 in billings by Murray, the vast majority of which were for services not rendered.

Bowie was indicted on one count of health care fraud and 13 counts of wire fraud, arising from a similar scheme. The indictment alleges that he billed for purported home care services rendered at times when, in reality, he was vacationing in Saudi Arabia, Jamaica, Colombia, and other destinations. As alleged, Bowie caused approximately $600,000 in Medicaid billings, the vast majority of which were fraudulent.

This case was investigated by the FBI, HHS-OIG, and IRS-CI and is being prosecuted by Assistant United States Attorneys Sara Solow and Angella Middleton.

***

In the third federal case, Khaleelah Williams, 49, and Saleemah Davis, 29, both of Philadelphia, and the home care agency they own, Benevolent Home Health LLC, have been charged with health care fraud conspiracy, health care fraud, and 14 counts of wire fraud. In addition, Williams and Davis have each been charged with two counts of aggravated identity theft.

The indictment alleges that Williams billed Medicaid for home care services purportedly provided by her husband, both while he was allegedly trafficking narcotics and after he was detained in federal custody on drug trafficking charges. Davis and Williams also billed for home care services purportedly performed by aide who was deceased. As alleged, Williams and Davis made approximately $224,000 in fraudulent claims to Medicaid.

The case was investigated by the DEA and HHS-OIG and is being prosecuted by Assistant United States Attorney Jessica Rice and Special Assistant United States Attorney Megan Curran.

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“This criminal conduct is much more than someone ‘working the system’ — the impact is deep and wide-ranging, as every dollar diverted deprives someone in need of care,” Pennsylvania Attorney General Dave Sunday said. “In collaboration with our partners, my office last year convicted more than 100 defendants, and clawed back more than $40 million that was intended for Pennsylvanians in need.”

“Medicaid fraud robs hardworking taxpayers, deprives vulnerable Americans of the care they need, and undermines the public trust that sustains our social safety net,” said CMS Administrator Dr. Mehmet Oz. “CMS will continue partnering with law enforcement to shut down these scams while establishing new anti-fraud safeguards that flag criminal activity before the money ever leaves the building. This Administration is taking a whole-of-government approach to protecting Medicaid — ensuring the program serves the Americans who depend on it, not criminals seeking to exploit it.”

“Today’s announcement underscores the need to confront Medicaid and Medicare fraud head on,” stated Department of Health and Human Services Inspector General T. March Bell. “The schemes alleged here involved fabricated services, impossible work hours, and claims made while defendants were incarcerated, overseas, or working other jobs. Together with our federal and state partners, we remain steadfast in protecting Medicaid and Medicare by pursuing anyone who seeks to exploit these programs and the people they are designed to serve.”

“Health care fraud is not a victimless crime — it undermines public trust and diverts critical resources from patients who need them,” said FBI Philadelphia Special Agent in Charge Wayne Jacobs. “No single agency can tackle complex health care fraud schemes alone. Let today’s announcement be a warning to those engaging in similar activity: if you seek to exploit our health care systems for personal profit, you should expect the FBI and our partners to uncover your scheme and bring it to an end. Every dollar stolen through fraud is a dollar diverted from patient care, and the FBI will continue its work to safeguard the public’s trust and hold accountable those who abuse these vital programs.”

“Health care fraud is not just a financial crime, it threatens public safety and victimizes the American people,” said DEA Philadelphia Special Agent in Charge Timothy Flaherty. “Our message is clear: if you are a medical provider who chooses greed over your professional responsibility, DEA will hold you accountable.”

“IRS Criminal Investigation enforces the nation’s tax laws but also takes particular interest in cases involving fraud against government health care programs,” said Yury Kruty, Special Agent in Charge of the IRS-CI Philadelphia Field Office. “With both law enforcement and financial investigation expertise, our agents are uniquely qualified to assist state, local and federal law enforcement agencies in these matters by tracing financial transactions. The success of these investigations is attributable to the collaborative efforts of our law enforcement partners.”

On April 7, the Department of Justice announced the creation of the National Fraud Enforcement Division (“Fraud Division”). The Fraud Division is laser-focused on investigating and prosecuting those who commit fraud against the American people. The Department’s work to combat fraud supports President Trump’s Task Force to Eliminate Fraud, a whole-of-government effort chaired by Vice President J.D. Vance to eliminate fraud, waste, and abuse within Federal benefit programs.

The charges and allegations contained in federal indictments and state complaints are merely accusations. Every defendant is presumed to be innocent unless and until proven guilty in court.

A man has been arrested in connection with a fraud investigation, according to SLED.

Matthew Coaxum, 45, has been charged with forgery and presenting a false claim for insurance.

Zanajia Wilson-James, 29, was previously charged with presenting a false claim for insurance in April.

Tikia Carter, 33, was previously charged with presenting a false claim for insurance in May.

According to the arrest warrant, Coaxum is accused of being a “jump-in” passenger in connection with a false insurance claim for a car accident in February 2025.

Coaxum claimed to be working at AWP Safety Services, reporting he missed work for 42 days and lost $12,012 in wages, according to the arrest warrant.

Authorities determined Coaxum was not working at AWP Safety Services at the time, nor was he in the vehicle during the accident.

Coaxum also claimed to be a passenger in Wilson’s car during an accident, according to the arrest warrant.

Authorities determined Coaxum was not working at AWP Safety Services at the time, nor was he in the vehicle during the accident.

Coaxum also claimed to be a passenger in Wilson’s car during an accident, according to the arrest warrant.

Authorities say Coaxum reported medical bills and lost wages totaling $30,662 and demanded $40,000 for pain and suffering, totaling out to $70,662.

The investigation revealed Coaxum was not in the car.

Coaxum was booked into the Alvin S. Glenn Detention Center.