Criminal charges have been filed against Caprice Mathies-Hill for allegedly submitting over $1 million in fraudulent claims to the state's Medicaid program

Wisconsin Attorney General Josh Kaul announced Thursday that criminal charges have been filed against 53-year-old Caprice Mathies-Hill of Milwaukee for allegedly submitting over $1 million in fraudulent claims to the state's Medicaid program. Emphasizing the importance of safeguarding public health funds, AG Kaul stated that Medicaid dollars must directly serve their intended coverage purposes and that state authorities take all attempts to defraud the system with complete seriousness.

According to the criminal complaint filed in Milwaukee County Circuit Court, Mathies-Hill operates an agency named Abby’s Clubhouse. Through this organization, she allegedly submitted false claims for prenatal care coordination and childcare coordination services between November 2020 and October 2023. These state programs are designed to connect expectant mothers and families with critical medical, social, and educational services. Although she submitted more than $1 million in total claims, Mathies-Hill allegedly received over $470,000 in unauthorized payouts before the scheme was uncovered.

Investigative findings indicate that the defendant enticed members to enroll with Abby’s Clubhouse by providing non-covered promotional items like diapers and baby wipes, which she then billed back to the state. Furthermore, she is accused of systematically billing Medicaid for hundreds of thousands of dollars in two-hour care appointments that were never actually conducted.

Consequently, Mathies-Hill faces multiple felony counts, including theft by fraud, wire fraud as a party to a crime, and two separate counts related to public assistance fraud involving kickbacks.

The ongoing prosecution is being handled by the Wisconsin Department of Justice following a referral from the Wisconsin Department of Health Services Office of the Inspector General. The state's Medicaid Fraud Control and Elder Abuse Unit led the official investigation. Authorities reiterate that all charges remain mere accusations at this stage, and the defendant is presumed innocent until proven guilty in a court of law.