Frederica Freyberg:

The Department of Health Services is cracking down on prenatal programs paid for by Medicaid, and now city and state elected officials are calling for accountability. The Milwaukee Journal Sentinel broke the story of millions of dollars being billed to Medicaid on the part of programs designed to improve birth outcomes for low income pregnant women. Wisconsin has the highest Black infant mortality rate in the nation, and narrowing disparities is a priority of health officials. According to its reporting, the newspaper found Wisconsin has seen a 400% increase in new applications to open prenatal care coordination companies in recent years, billing Medicaid thousands of dollars per client and making newly minted millionaires out of company owners. The Department of Health Services reports it has referred four companies to the state Justice Department for criminal investigation. Our next guest says she’s been trying to sound the alarm on corruption in the prenatal industry for years. Bria Grant joins us now. Thanks very much for doing so.

Bria Grant:

Good afternoon. Thank you for having me.

Frederica Freyberg:

I want to point out you’re the executive director of an organization that trains community health workers and have worked in prenatal care as well including on a state-wide level to improve such care. Why have you been sounding the alarm on this burgeoning industry?

Bria Grant:

Well, let me just be clear, just really quickly, not just prenatal care but chronic conditions. Our work is around addressing social disparities, which contribute to poor health outcomes. And so essentially that is what we want to improve in our state. Our state leads in poor health outcomes for children of color, as well as chronic conditions for people of color. So we want to make sure that while we are spending the dollars, which we want to have the investment, but the investment should correlate with improvement of birth outcomes.

Frederica Freyberg:

But you saw this happening, thereby trying to sound the alarm on fraud?

Bria Grant:

So one of the things I will say, you know, sometimes people just don’t know, right? So there are no checks and balances for ensuring who are facilitating processes appropriately. So you just continue to do the things you’ve been allowed to do. Our goal is to ensure that there is a process of accountability for both at the state level and the community level, where services are being delivered, so that we can see that improved outcome in birth outcomes.

Frederica Freyberg:

Absolutely. Can you give us an example of how fraud might be perpetrated in this prenatal care industry?

Bria Grant:

Well, you know, sometimes you have individuals who don’t have a method of identifying if a client is working with someone else, and so they may engage them in services as well and bill for services that are also being provided in and billed through another agency. Sometimes it’s known, sometimes it’s not known. Additionally, individuals may provide care to multiple families, documenting sometimes the same time that they’re delivering this care, where if we had a process that helped to be able to better track that engagement with families, we significantly reduce some of that duplication of work.

Frederica Freyberg:

So four Milwaukee companies have now had their Medicaid reimbursements cut off. In your mind, is that kind of too long in coming?

Bria Grant:

Well, absolutely, right, because it just took so long to get here before it was recognized that these moms weren’t being served. And I think that’s the larger issue. While of course we want to make sure we’re spending our dollars responsibly, there are families that are not receiving the services that’s being reported to have been received. And so that definitely is an issue when we think of infant mortality, the disparity between Black and whites is just disheartening. In Milwaukee, while there’s been an overall decline in infant mortality, for Blacks, it’s 14.9 and for whites, it’s 4.6. So to have that gap is a huge issue, and to know that we have the dollars for the investment to improve on that and that it’s not coming together is really what we want to address.

Frederica Freyberg:

Because also, there are legitimate prenatal care companies doing good work in this way. Can you tell me about the kind of work that those companies are doing?

Bria Grant:

Absolutely. At UniteWI, we train a plethora of community coordinators, community health workers. Agencies use us as a go-to for formalized training. The model that we facilitate has been shown to improve birth outcomes significantly and have a cost savings associated with it. And again, this is not just in birth outcomes, we know that a large number of our moms experience hypertension during their pregnancy, so being able to address that so that we can have a healthy birth weight, as well as take moms to full term is a part of the work that we’re doing.

Frederica Freyberg:

With less than a minute left, what goes in to assuring these good health outcomes for babies and mothers?

Bria Grant:

Absolutely. So when we think about our health, 20% is in the four walls of the clinic, are physical. The other 80% of our whole health is where we work, sleep, eat and play. So if mom’s stressors are not managed, if I have housing issues, if I have unhealthy eating practices because I just don’t have the education, if I don’t have access to the proper resources to bring stability to my life, then that’s going to cause me to have a stressor that may create high blood pressure, that may create stress in the womb that doesn’t allow for me to have the healthy birth outcome. So the work we do is to train those community health workers on how to address the whole family, including bringing the father into the picture, because that’s a huge component to a healthy birth outcome and a mom’s stressors. So that is what we want to make sure, that we have a whole health approach to ensuring our family can be healthy.

Frederica Freyberg:

Great information. Bria Grant, thank you very much.

Bria Grant:

Thank you.