Wisconsin officials crack down on fraud-ridden infant mortality program

After finding that millions of dollars meant to prevent infant mortality actually went into the pockets of fraudulent operators, the state is cracking down on those scamming the program.

"These women and children deserve better," said Kirsten Johnson, who became the head of the state Department of Health Services earlier this year.

Johnson said she was shocked by the extent of fraud found by the agency's Office of the Inspector General in the program created to combat Wisconsin's dire problem of babies dying before their first birthday.

The fraud was so rampant that the office has referred 20 Medicaid providers to the state Department of Justice's Medicaid Fraud Control Unit for "engaging in suspected fraudulent activity" involving false claims.

"One of the things that moved me the most at the end of the summer was that we had been billed for over $2 million in claims, and $20,000 of those were legitimate," Johnson told the Journal Sentinel Friday. Those figures only include claims from the end of May to October.

The crackdown comes after a 2022 Journal Sentinel investigation revealed massive fraud in the program, known as prenatal care coordination, or PNCCs. 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.

Johnson said that when she was Milwaukee's health commissioner, she saw signs of fraud in the program — including double billing and charging for services that were not provided.

"It was clear to me that at that point that there was some challenges in the program in terms of fraud," Johnson said. "And then obviously your article highlighted a lot of those things."

Now DHS, which oversees the program, is taking steps to overhaul it.

"I just think it is a huge disservice to the women and children in Milwaukee and it's unacceptable," Johnson said. "But that said, I think we're acting."

The crackdown includes:

• Conducting a comprehensive review of all current providers, including every submitted claim.

• Seeking authority from federal officials to only enroll new PNCC providers "who do not have major indicators of fraud." That includes blocking former employees of fraudulent PNCCs from opening their own operations.

• Implementing a "payment integrity review" for all claims submitted to the child care coordination program, a sister program that provides services for children who age out of the PNCC program.

Black babies in Wisconsin are three times more likely to die than white babies, and Black women here are five times more likely to die during pregnancy and in childbirth than white women, statistics show.

"Wisconsin's disparities in maternal and infant health outcomes are preventable and unjust," Johnson said in a statement. "We have worked to identify and hold accountable bad actors to ensure Wisconsin women and children receive the services they need and deserve for which Medicaid has been billed."

Two former PNCC owners, Markita Barnes and Precious Cruse, are facing felony charges for fraud in federal court in Milwaukee.

Barnes, who was the owner of one of Wisconsin's largest prenatal care companies, is charged with improperly pocketing $2.3 million in Medicaid money.

Cruse is charged with with illegally taking more than $700,000 while running her own PNCC.

Both have denied any wrongdoing.

Johnson said the program is valuable and will continue.

"I do believe there are legitimate and good providers. And I also know that the need is so significant in Milwaukee that I want the women who are receiving the services to continue," Johnson said, adding that officials are working to "wrap our arms around the fraud and shut it down."

This article originally appeared on Milwaukee Journal Sentinel: Wisconsin cracks down on fraud-ridden infant mortality program