Prenatal Care Agency Owner Charged With Defrauding Medicaid of More Than $1 Million in Wisconsin
The Wisconsin Department of Justice announced on November 5 that Attorney General Josh Kaul said criminal charges have been filed against a Milwaukee woman for allegedly submitting more than $1 million in fraudulent claims to the Wisconsin Medicaid program. The case, filed in Milwaukee County, involves an agency that provided prenatal and childcare coordination services.
According to the criminal complaint, Caprice Mathies-Hill, 53, through her agency, Abby's Clubhouse, allegedly defrauded the state's Medicaid program by submitting prenatal care coordination (PNCC) and childcare coordination (CCC) claims for services that were never provided. PNCC programs are referral-based services designed to connect at-risk pregnant women with medical, social and educational services to improve birth outcomes, while CCC programs connect families with educational and health services.
Per the complaint, Mathies-Hill allegedly enrolled members in Abby's Clubhouse by offering them non-covered items such as diapers or baby wipes and submitting reimbursement claims for them. She then allegedly billed Medicaid hundreds of thousands of dollars for two-hour care services that never occurred. Abby's Clubhouse submitted PNCC or CCC claims for services from about November 2020 to October 2023.
Of the more than $1 million in claims submitted, prosecutors allege Mathies-Hill was paid more than $470,000 to which she was not entitled. She is charged in Milwaukee County Circuit Court with one count of theft by fraud, one count of public assistance fraud (offering a kickback), one count of public assistance fraud as a party to the crime (providing a kickback), and one count of wire fraud as a party to the crime.
"Medicaid dollars must go toward the services they're intended to cover," said Attorney General Kaul. "We take alleged attempts to defraud the system seriously."
The case was referred to the state Department of Justice by the Wisconsin Department of Health Services, Office of the Inspector General. The investigation was led by the Wisconsin DOJ Medicaid Fraud Control and Elder Abuse Unit, and the Wisconsin DOJ is prosecuting the case. Mathies-Hill told the Milwaukee Journal Sentinel, "I haven't done anything that's criminal." The Justice Department noted that the charges are merely accusations and that the defendant is presumed innocent unless and until proven guilty.
Source: Wisconsin Department of Justice
Published by GSM · USA (original Chinese edition)
Photo: 图：位于 Madison 的威斯康星州议会大厦，威斯康星州政府所在地；本案由威斯康星州司法部提起指控。Michael Barera 摄，CC BY-SA 4.0，经 Wikimedia Commons。 / Photo: The Wisconsin State Capitol in Madison, seat of the state government; the case was charged by the Wisconsin Department of Justice. By Michael Barera, CC BY-SA 4.0, via Wikimedia Commons.
