Citing fraud concerns, state cuts off funding to four more firms in infant mortality program
The state has cut off funding to four more agencies created to prevent infant mortality as its crackdown on widespread Medicaid fraud in the program continues, documents show.
Three of the suspensions came last week and the fourth occurred in August, according to records released by the state in response to a Milwaukee Journal Sentinel request under the state open records law. The amount of Medicaid funds paid to the four companies whose funding was suspended was not available on Wednesday.
Letters to the owners of each of the Milwaukee-area prenatal care coordination companies, known as PNCCs, say the suspensions are because the state found "credible allegations of fraud," including billing for services that were not provided.
Funding was cut off to Abby's Clubhouse in August. Two companies, Generation of Excellence Trendsetters and JMJ Consulting, received suspension letters on Dec. 5. Whitmore International was suspended two days later.
The owners of Abby's Clubhouse and Generation of Excellence both denied wrongdoing. The owners of the other two companies could not be reached Wednesday for comment.
The suspensions are the latest in the ongoing probe of the fraud-ridden program by state and federal regulators and law enforcement officials. At least 20 Medicaid-funded providers have been referred to the state Department of Justice's Medicaid Fraud Control Unit and two former prenatal care company owners have been charged with fraud-related felonies in federal court. Both of those owners — Markita Barnes and Precious Cruse — have denied wrongdoing and are fighting the charges in federal court.
LaTonya Baker, the owner of Generation of Excellence Trendsetters, denied wrongdoing. Regulators charge that her company billed the program for services that were not provided.
"All I can say is it's not true," Baker said Wednesday. "The way that they did their investigation, they're basically looking at all PNCC agencies as if we're all doing the same things. And that's not true."
Baker complained that during the state's probe, investigators seized records and files from her company.
"The first I knew my agency was in trouble was when they took my files from my office," Baker said.
The crackdown comes after a 2022 Journal Sentinel investigation revealed massive fraud in the state's prenatal care coordination program. Wisconsin has long had one of the nation's worst records for Black infant mortality, a troubling rate that has shown little improvement over the years. In Wisconsin, Black babies are three times more likely to die than white babies, and Black women are five times more likely to die from complications linked to pregnancy and childbirth.
The goal of the prenatal care coordination program is to improve birth outcomes and help low-income pregnant women and mothers of young children gain access to medical, educational and social services. Prenatal care coordination companies are supposed to provide a wide range of services, including risk assessments, care plans, and health and nutrition counseling.
Kirsten Johnson, who became the head of the state Department of Health Services earlier this year, said in an interview last month that combatting fraud in the program is a priority. She noted that at the end of the summer, the state had been billed for more than $2 million in claims, even though only $20,000 was legitimate.
She could not be reached immediately for comment Wednesday.
Caprice Mathies, owner of Abby's Clubhouse, whose funding was suspended in August, put some of the blame on the state.
"We feel like we don't have the support that we would like," Mathies said Wednesday. "I think PNCC and CCC (child care coordination) providers are possibly not seen as viable providers of health care. "
Regulators say her company submitted claims and received payment for services that were not provided, submitted "claims prior to when services were purportedly performed," and didn't comply with several Medicaid regulations.
Mathies said the services her company provided to women were necessary "to their emotional well-being, their physical well-being and their financial situation."
Mathies said she has appealed the suspension. A state spokeswoman confirmed the appeal is pending.
In the case of Whitmore International, investigators found "evidence of falsifying medical records, misrepresenting the services billed to the Medicaid program, and submitting false claims," according to a letter from the state Department of Health Services.
Including this latest round of suspensions, the state has cut off funding to 11 providers since the Journal Sentinel began examining the industry.
Contact Mary Spicuzza at (414) 224-2324 or mary.spicuzza@jrn.com. Follow her on Twitter at @MSpicuzzaMJS. Contact Cary Spivak at (414) 550-0070 or cspivak@jrn.com. Follow him on Twitter at @cspivak.
This article originally appeared on Milwaukee Journal Sentinel: Citing fraud, state suspends funding to four more firms in infant mortality program
