产前护理机构负责人被控骗取Medicaid逾100万美元：以尿布招揽入会、虚报从未提供的服务
威斯康星州司法部11月5日宣布，州检察长 Josh Kaul 表示，该部已对 Milwaukee 一名女子提起刑事指控，指控她向威斯康星州 Medicaid 医疗补助计划提交逾 100 万美元的虚假申报。案件发生在威斯康星州 Milwaukee 县，被告经营的机构为孕妇与家庭提供产前和育儿协调服务。
起诉书指，53 岁的 Caprice Mathies-Hill 通过其经营的机构 Abby's Clubhouse，申报产前护理协调（PNCC）与育儿协调（CCC）服务费用，但这些服务从未实际提供。PNCC 是转介型服务，旨在把高风险孕妇与医疗、社会和教育服务连接起来以改善分娩结局；CCC 则帮助家庭对接教育与健康服务。
检方称，Mathies-Hill 以尿布、婴儿湿巾等不在承保范围内的物品招揽会员加入 Abby's Clubhouse，并为这些物品申报报销；随后，她又按两小时护理服务的标准向 Medicaid 申报了数十万美元费用，而这些服务从未发生。该机构提交 PNCC 或 CCC 申报的时间跨度约为 2020 年 11 月至 2023 年 10 月。
在逾 100 万美元的申报总额中，检方指 Mathies-Hill 实际领到了逾 47 万美元她无权领取的款项。她在 Milwaukee 县巡回法院被控四项罪名：一项欺诈盗窃、一项提供回扣的公共援助欺诈、一项作为共犯提供回扣的公共援助欺诈，以及一项作为共犯的电汇欺诈。
州检察长 Josh Kaul 说：「Medicaid 的钱必须用在它本应承保的服务上。我们严肃对待任何涉嫌诈骗这一系统的行为。」
此案由威斯康星州卫生服务部督察长办公室移送州司法部，调查由该部 Medicaid 欺诈控制与虐老组主导，检控亦由威斯康星州司法部负责。Mathies-Hill 对《Milwaukee Journal Sentinel》表示：「我没有做过任何犯罪的事。」司法部在公告中强调，以上指控仅属指控，被告在被证明有罪之前依法推定无罪。
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.
来源：威斯康星州司法部
发布：GSM·美国（发布链接）
图片来源：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.
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