Franklin Rural Health Clinic and Its President Doctor Sentenced on Health Care Fraud Charges

The United States Attorney’s Office for the Southern District of Illinois, announced today that on February 18, 2010, JAMES PHILLIP DURHAM, M.D., age 72, of West Frankfort, and President of FRANKLIN RURAL HEALTH CARE CLINIC, an Illinois corporation, doing business in Christopher, was sentenced for making false statements to a federal health care program. FRANKLIN RURAL HEALTH CARE CLINIC was also sentenced for health care fraud. Both DURHAM and FRANKLIN RURAL HEALTH CARE CLINIC were sentenced to probation for two years.

The charging documents indicate that DURHAM instructed clinic employees to bill Medicare and Medicaid for non-covered medical services. Medicare was fraudulently billed for $42,503.00 from January 1, 2003 through May 31, 2006. During that same time frame, Medicaid was improperly billed $145,388.46. The total loss amounts to $187,841.86.

The United States Attorney’s Office also prosecuted the defendants in a civil fraud enforcement action. The defendants agreed to settle and have paid $360,357.22 to settle the civil enforcement action. The action contended that the defendants engaged in fraudulent conduct from January 1, 2003 to May 31, 2006, by submitting or causing to be submitted false claims from rural health clinic patient encounters (visits).

The cases were investigated by the U.S. Department of Health and Human Services, Office of Inspector General; the Illinois State Police; and the Federal Bureau of Investigation. The criminal cases were prosecuted by Assistant United States Attorney Liam Coonan. The civil actions were prosecuted by Assistant United States Attorney Gerald M. Burke.

If you suspect or know of an individual or company that is not complying with healthcare laws or public aid programs, you may report this activity to the local office of the U.S. Department of Health Human Services, Office of Inspector General or call 1-800-447-8477.