UKRAINE - 2021/01/08: In this photo illustrations handcuffs and hundred us dollar banknotes seen displayed. (Photo Illustration by Mykola Tys/SOPA Images/LightRocket via Getty Images)
MILWAUKEE - Wisconsin prosecutors say a 53-year-old Milwaukee woman fraudulently filed more than $1 million in claims to Medicaid for services that weren't real.
$1 million Medicaid fraud scheme
The backstory:
According to the Wisconsin Department of Justice, between around Nov. 2020 and Oct. 2023, the woman submitted more than $1 million in claims and was paid more than $470,000 she was not entitled to receive. Prosecutors say the billing went through her agency, Abby’s Clubhouse, for prenatal care coordination (PNCC) and childcare coordination (CCC).
PNCC programs are services that connect at-risk pregnant women with medical, social and educational services to improve birth outcomes. Similarly, CCC programs are for families who would like to be connected to educational and health services to improve health outcomes.
According to officials, the woman allegedly enrolled members in these programs through Abby's Clubhouse and offered them non-covered items such as diapers or baby wipes and would then submit reimbursement claims for them.
On top of that, she allegedly would then bill Medicaid thousands of dollars for two hours of care services that never happened.
What's next:
The woman has been charged by the Wisconsin Department of Justice with the following charges:
- Theft by Fraud (Class F Felony)
- Wire Fraud, as a Party to the Crime (Class H Felony)
- Public Assistance Fraud (offering a kickback) (Class H Felony)
- Public Assistance Fraud, as a Party to the Crime (offering a kickback) (Class H Felony)
The Source: This story was written using information from a press release shared by the Wisconsin Department of Justice and was reported out of Eden Prairie, Minnesota.