Dept. of Justice: Milwaukee Woman Charged for Alleged Scheme to Defraud Wisconsin Medicaid of More Than $1 Million

MADISON, Wis. – Attorney General Josh Kaul on Thursday announced that criminal charges have been filed by the Wisconsin Department of Justice (DOJ) against a Milwaukee woman for allegedly submitting more than $1 million in fraudulent claims to the Wisconsin Medicaid program.

“Medicaid dollars must go toward the services they’re intended to cover,” said AG Kaul. “We take alleged attempts to defraud the system seriously.”

Of the more than $1 million in claims the complaint alleges the defendant, Caprice Mathies-Hill, 53, submitted, she was allegedly paid more than $470,000 to which she was not entitled. Mathies-Hill 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.

According to the criminal complaint, Mathies-Hill, through her agency, Abby’s Clubhouse, is alleged to have 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 that are designed to connect at risk pregnant women with medical, social, and educational services to improve birth outcomes. CCC programs are intended to connect families with educational and health services to improve health outcomes.

Per the criminal complaint, the defendant is alleged to have enrolled members in Abby’s Clubhouse by offering them non-covered items such as diapers or baby wipes and submitting reimbursement claims for them. The defendant is then alleged to have billed Medicaid hundreds of thousands of dollars’ worth of two-hour care services that never occurred.

Abby’s Clubhouse submitted PNCC or CCC claims for services from about November 2020 to October 2023.

These charges are merely accusations. As in any criminal case, the defendant is presumed innocent unless and until proven guilty. 

This case was referred to DOJ by the Wisconsin Department of Health Services – Office of the Inspector General. This investigation was led by the Wisconsin DOJ Medicaid Fraud Control and Elder Abuse Unit. Wisconsin DOJ is prosecuting the case.

The State of Wisconsin Medicaid Fraud Control and Elder Abuse Unit receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $1.97 million for Federal fiscal year (FY) 2026. The remaining 25 percent, totaling $660,000 for FY 2026, is funded by the State of Wisconsin.