Santa Fe Heart Doctor Admits to Fraud Scheme

ALBUQUERQUE, NM – Roy G. Heilbron, 53, a cardiologist practicing in Santa Fe, New Mexico, has confessed to defrauding the healthcare system, pleading guilty to one count of federal health care fraud in Albuquerque federal court today. The plea, accepted by the court, sets the stage for a two-year federal prison sentence followed by a period of supervised release, the length of which will be determined at a later date. Heilbron’s fall from grace marks another instance of medical professionals exploiting the system for personal gain, a recurring theme in Grimy Times’ coverage.

The case, initially brought forward in a 24-count indictment filed in June 2015, detailed a systematic scheme spanning from January 2010 to May 2011. Prosecutors alleged that Heilbron, licensed to practice medicine in New Mexico and specializing in cardiology, deliberately submitted false and fraudulent claims to Medicare and other health benefit programs. The indictment painted a picture of a doctor prioritizing profit over patient care, ordering and billing for a litany of unnecessary tests on every new patient.

The depth of the alleged deception was staggering. According to court documents, Heilbron didn’t simply overbill; he actively fabricated patient records. He inserted false symptoms, observations, and diagnoses to justify the unnecessary tests. When documentation was requested by insurance companies, he allegedly provided photocopied clinical notes, test results, and even ultrasound images – records of procedures either never performed or insufficiently documented. He also submitted claims for procedures never rendered, and manipulated billing codes to maximize reimbursement rates, essentially padding his income at the expense of the healthcare system and, ultimately, taxpayers.

Counts 1 through 9 of the indictment centered around submitting false claims for medical services on nine separate dates between July 13, 2010, and February 10, 2011. Counts 10 through 21 focused on falsified medical records submitted on twelve occasions between January 20, 2010, and May 5, 2011. The final three counts, 22 through 24, alleged wire fraud, asserting that Heilbron used wire communications to illicitly obtain payments from healthcare benefit programs. While Heilbron only pled guilty to Count 4 – a specific instance of health care fraud – he has agreed to pay restitution covering the entirety of the alleged fraudulent activity.

During today’s change of plea hearing, Heilbron admitted to operating his fraudulent scheme through A Well for Health Church, Inc., a medical clinic in Santa Fe, contracting with both Blue Cross and Blue Shield of New Mexico and Medicare. He acknowledged billing these programs for services provided to patients and including medical diagnoses as justification for compensation. The prosecution will now present evidence to determine the total amount of restitution owed, a figure expected to be substantial given the scope of the alleged fraud. This case serves as a stark reminder that even those entrusted with our health can be driven by greed, and that federal authorities are actively pursuing those who exploit the system.

The investigation was conducted by the FBI’s Albuquerque Division, led by Special Agent in Charge Terry Wade, alongside the U.S. Attorney’s Office for the District of New Mexico, headed by U.S. Attorney Damon P. Martinez. While Heilbron awaits sentencing, this case remains a cautionary tale, highlighting the ongoing battle against healthcare fraud and the commitment of federal agencies to hold perpetrators accountable. Grimy Times will continue to follow this case and report on the final sentencing and restitution amount.