Missouri man sentenced for fraud scheme to overcharge Medicaid, Medicare at four clinics

Fraud Scheme

A Springfield, Mo., man who operated four Family Medical Center clinics in southern Missouri was sentenced in federal court for health care fraud.

Michael A. Tucker, 47, of Springfield, was sentenced by U.S. District Judge Gary A. Fenner to one year and one day in federal prison. The court also ordered Tucker to pay $54,273 in restitution.

On March 30, 2016, Tucker pleaded guilty to health care fraud. Tucker was the owner of four Family Medical Center clinics in Carthage, Mo., Branson, Mo., Nevada, Mo., and Lamar, Mo. In June 2015, Tucker closed his clinics and Family Medical Centers ceased doing business. 

Tucker admitted that he defrauded Medicaid and Medicare by submitting claims to the government for more expensive treatment than was provided at his clinics. Although the physicians and nurse practitioners at Tucker’s clinics accurately recorded the services they provided, Tucker billed Medicaid and Medicare for more expensive services. The Medicaid scheme lasted from Jan. 1 to June 30, 2014. The Medicare scheme lasted from April 15, 2013, to Sept. 24, 2014.

Specifically, Tucker routinely billed Medicaid for more complex office visits than were actually provided. In addition, Tucker routinely billed both Medicaid and Medicare for the services of physicians when the patient had actually been seen by a nurse practitioner. Lastly, Tucker billed Medicaid for physician office visits when only laboratory services had been provided. In each of these instances, Tucker’s conduct resulted in his clinics receiving greater reimbursement than they were entitled to from Medicaid and Medicare.

The Missouri Attorney General’s Medicaid Fraud Control Division led the initial investigation into Tucker’s conduct and then assisted the United States Attorney’s Office, Western District of Missouri and the Office of the Inspector General for the United States Department of Health and Human Services in Tucker’s prosecution.