A 53-year-old Milwaukee woman is facing criminal charges after Wisconsin officials accused her of running a Medicaid billing scheme worth more than $1 million through her early intervention agency, Abby's Clubhouse. Caprice Mathies-Hill allegedly submitted claims for prenatal and childcare coordination services that were never provided, collecting hundreds of thousands of dollars she was not entitled to in the process.
Wisconsin Attorney General Josh Kaul announced the charges Thursday, according to wispolitics.com. The criminal complaint alleges Mathies-Hill submitted more than $1 million in fraudulent claims to Wisconsin Medicaid and was paid more than $470,000 to which she was not entitled. She faces charges including theft by fraud, wire fraud as a party to the crime, and public assistance fraud, according to WISN, which reported two of the public assistance fraud counts stem from an allegedly offered kickback.
Claims Stretched Over Nearly Three Years
The alleged scheme ran from about November 2020 to October 2023, per the same wispolitics.com account, during which Abby's Clubhouse submitted prenatal care coordination and childcare coordination claims for services the complaint says were never actually delivered. Prenatal care coordination programs typically use referrals to connect at-risk pregnant women with medical, social, and educational services aimed at improving birth outcomes, while childcare coordination programs link families to educational and health resources meant to improve children's health outcomes, per WISN's reporting.
Investigators also allege Mathies-Hill enrolled members in Abby's Clubhouse by offering items not covered by Medicaid, including diapers or baby wipes, and then submitted reimbursement claims for those non-covered items, according to WISN. The dollar amount tied to one piece of the alleged scheme is disputed: wispolitics.com reported the complaint describes hundreds of thousands of dollars in billing for two-hour care services that never occurred, while FOX6 reported the figure for those same services was thousands of dollars.
DOJ Says It Takes Fraud Allegations Seriously
The case was referred to the Wisconsin Department of Justice by the Wisconsin Department of Health Services' Office of the Inspector General, the state said in its announcement. Kaul said his office takes alleged attempts to defraud Medicaid seriously, according to the state's release. Officials emphasized that the charges remain accusations and that Mathies-Hill is presumed innocent unless and until proven guilty.
Part of a Broader Pattern in Wisconsin
The Mathies-Hill case follows several other recent Wisconsin Medicaid fraud prosecutions involving prenatal and childcare coordination providers. Earlier this year, Milwaukee provider Debbie Long, 44, was charged with allegedly defrauding the state's Medicaid program of almost $2.2 million, with investigators alleging at least $2.1 million in reimbursements to Pinnacle Home Health Care for services that were never performed, according to the Wisconsin Examiner.
In September, Fortunate Futures founder Demaryl Howard was sentenced to two and a half years in federal prison after pleading guilty to felony health care fraud, the Wisconsin Law Journal reported. Prosecutors said Howard had submitted more than $5 million in Medicaid bills, resulting in more than $4.3 million in improper payments. The same outlet noted that several owners of prenatal care coordination companies have been convicted of felonies in recent months, underscoring increased scrutiny of the program statewide.
