A group of six women from the Milwaukee area are being investigated by the U.S. Department of Health Services for their alleged roles in a scheme to defraud the Wisconsin Medicaid program. The women carried out this scheme by operating several prenatal and childcare businesses.
The group of women is accused of billing Wisconsin Medicaid for more than $8.6 million worth of prenatal care coordination (PNCC) and child care coordination (CCC) services that weren’t actually provided, according to a search warrant application filed in United States District Court for the Eastern District of Wisconsin.
The search warrant application was filed by a special agent with the U.S. Department of Health and Human Services Office of Inspector General (HHS/OIG). The special agent is trained to investigate cases involving health care fraud.
Between August 2019 and October 2021, Wauwatosa-based
Generation of Excellence Prenatal Care (GOEPC) received $2.18 million from Wisconsin Medicaid. From December 2019 to May 2023, Glendale-based
JMJ Consulting LLC (JMJ) received $4.9 million from Wisconsin Medicaid. From April 2022 to May 2023, Wauwatosa-based
Generation of Excellence Trendsetters (GOET) received $1.5 million from Wisconsin Medicaid. These amounts were the highest in the state, according to the search warrant application, and totaled over $8.6 million. All three business entities were run by the same group of women.
"Special agents believe that this money was received by GOEPC, GOET, and JMJ because of fraudulent PNCC and CCC claims that the businesses submitted to Wisconsin DHS," according to the search warrant application.
The search warrant application, filed last month, sought approval to retrieve information from four different Google accounts used by the women who purported to be PNCC and CCC service providers.
PNCC and CCC services are reimbursed by Wisconsin Medicaid. Providers of PNCC and CCC services are required to submit “accurate and truthful” claims for payments and to only seek reimbursement for the actual amount of time spent helping a client.
GOEPC was co-owned by
Alicia Washington,
Shantera Cole and
Latonya Baker before being dissolved in September 2021. Before GOEPC was dissolved, Baker applied with the Wisconsin Department of Health Services to start her own agency, called GOET. Prior to receiving approval to start GOET, Baker partnered with
Melissa Bonds to run JMJ, an approved PNC and CC provider.
Two women who worked for the aforementioned businesses are also listed in the search warrant application. They are
Inez Johnson and
Grisel Delgado.
Once GOET received state approval, an additional $1.5 million believed to be from fraudulent claims was sent from Wisconsin Medicaid and deposited into the GOET business bank account, according to the search warrant application.
PNCC and CCC billing records for GOEPC and JMJ also contained “multiple indicators for fraud,” reads the search warrant application.
Bank records show that between December 2019 and May 2023, $6.4 million from Wisconsin Medicaid was deposited into the JMJ and GOET business bank accounts owned by Baker, Bonds and Johnson.
Johnson used part of this money to “travel, gamble at casinos and shop at high-end retailers,” according to the search warrant application.
In February 2022, the state began receiving complaints from clients who said they were unaware JMJ had enrolled them in the company’s program and that JMJ continued to bill Wisconsin DHS using their personal information. JMJ submitted 11 claims later determined to be false.
Undercover operation
Last February, an IRS undercover agent completed a new client contact form through the JMJ website. The agent later connected with a JMJ care coordinator, who emailed the undercover agent a care plan listing the services she would be receiving.
The undercover agent gave the care coordinator a fake child’s name and fake Medicaid numbers to receive these services. The agent texted the care provider several times to inquire about services, but never received any of the items promised. Wisconsin DHS later received five separate claims for services provided to the fake child.
In June, a search warrant was executed, and information stored within Facebook accounts belonging to Baker, Bonds, Delgado, Johnson, Washington and Cole was obtained.
One Facebook message sent from Washington to Cole said, “(LaTonya Baker) referred a client to (Inez Johnson) and the baby is ten months. She wants to do some back billing but I’m not on that.”
Another Facebook message sent from Baker to Washington read, “"Good morning, even though Terry has that client with the 7-month-old, I’m not going to show her how to back bill unless she mentions it."
"The Facebook messages that special agents discovered, show (the group of women) conspiring to engage in fraudulent Medicaid billing practices," according to the search warrant application. "Specifically, these individuals discussed back dating claims, copying billing information from previously approved CCC claims, and billing the maximum allowable number of units for services."
Last November, special agents executed the search warrant at each woman’s respective residence and interviewed each person involved in the alleged scheme.
