Roy G. Heilbron, Health Care Fraud, New Mexico 2015

ALBUQUERQUE – In a shocking turn of events, Roy G. Heilbron, a 53-year-old cardiologist from Santa Fe, pleaded guilty today in federal court in Albuquerque to a health care fraud charge, announced U.S. Attorney Damon P. Martinez and Special Agent in Charge Terry Wade of the FBI’s Albuquerque Division.

Heilbron, who practiced medicine in Santa Fe, will be sentenced to two years in federal prison followed by a term of supervised release to be determined by the court. The cardiologist was charged with health care fraud and wire fraud charges in a 24-count indictment that was filed in June 2015.

According to the indictment, Heilbron executed a scheme to defraud Medicare and other health care benefit programs between January 2010 and May 2011 by submitting false and fraudulent claims. The scheme involved performing and billing for a wide array of unnecessary tests on every new patient and submitting false diagnoses with the billing claims to justify the tests to the insurance plans.

Heilbron also inserted false symptoms, observations, and diagnoses into patients’ medical charts to provide written support for the tests he ordered or performed. In addition, he inserted photocopied clinical notes, diagnostic test results, and ultrasound images in patients’ medical charts to create a written record of procedures that were either not performed or that had not been sufficiently documented to support the billing.

The indictment alleged that Heilbron submitted the photocopied notes, results, and images to the insurance plans when the plans requested documentation to support the claims submitted. He also submitted claims to health plans for procedures that were never performed and submitted claims for procedures performed on two consecutive dates to increase the amount paid for services that were actually rendered together on one single date.

Heilbron’s scheme was uncovered after a thorough investigation by the FBI and the U.S. Attorney’s Office. The cardiologist will be sentenced to two years in federal prison and will be required to pay restitution based on all of the criminal conduct charged in the indictment. The amount of restitution will be determined by the court after the presentation of evidence and argument by the parties.

This case highlights the importance of holding healthcare professionals accountable for their actions. We will continue to work tirelessly to protect the public and ensure that those who engage in healthcare fraud are brought to justice.

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