Caprice Mathies-Hill, 53, owner of Abby’s Clubhouse, faces felony charges after prosecutors say she submitted more than $1 million in fraudulent Medicaid claims for prenatal and child-care coordination services that were never delivered.
The case, filed in Milwaukee County Circuit Court, accuses Mathies-Hill of one count each of theft by fraud, public assistance fraud, public assistance fraud as a party to a crime, and wire fraud. State Attorney General Josh Kaul’s office said she was paid over $470,000 she was not entitled to for claims submitted between November 2020 and October 2023.
“Medicaid dollars must go toward the services they’re intended to cover,” Kaul said in a statement. “We take alleged attempts to defraud the system seriously.”
Mathies-Hill denied wrongdoing, telling the Milwaukee Journal Sentinel, “I haven’t done anything that’s criminal.”
Abby’s Clubhouse operated as a prenatal care coordination (PNCC) provider. These companies connect low-income pregnant women and new mothers with health services, counseling, and referrals to reduce infant mortality. Wisconsin’s PNCC and related child-care coordination programs have instead become a recurring source of taxpayer losses, according to state investigators and a Journal Sentinel series.
Funding to Abby’s Clubhouse was cut off about three years ago amid fraud concerns. At the time, Mathies-Hill told the newspaper she felt unsupported: “We feel like we don’t have the support we would like. I think PNCC and CCC providers are possibly not seen as viable providers of health care.”
The Wisconsin Department of Health Services Office of the Inspector General referred the charges, and the Department of Justice’s Medicaid Fraud Control and Elder Abuse Unit investigated them. Prosecutors say the agency billed for services never provided.
Investigation into Milwaukee-area PNCCs found multiple operators billing for nonexistent services, using “community baby showers” to collect mothers’ Medicaid numbers, and submitting claims for products or visits that never occurred. Several other owners and associates have faced similar charges.
Mathies-Hill’s case is the latest. The state has not released a full accounting of how much has been recovered across the PNCC sector or how many additional providers remain under review.
Critics of the PNCC model have long argued that loose eligibility rules, weak service verification, and limited real-time auditing created an environment where fraud could flourish while the stated goal of reducing infant deaths saw little measurable improvement. State officials have repeatedly promised tighter controls; the latest charges indicate those controls have not eliminated the problem.
