Santa Fe Physician Arraigned on Federal Indictment Alleging Scheme to Defraud Medicare and Other Health Care Benefit Programs
ALBUQUERQUE—Roy G. Heilbron, 51, a cardiologist in Santa Fe, N.M., was arraigned in federal court in Albuquerque, N.M., on a 24-count indictment charging him with health care fraud and wire fraud, announced Damon P. Martinez and Special Agent Carol K.O. Lee of the FBI’s Albuquerque Division. Heilbron entered a not guilty plea and was released on his own recognizance
The indictment alleges that Heilbron, a physician licensed to practice medicine in New Mexico who specializes in cardiology, executed a scheme to defraud Medicare and other health care benefit programs between Jan. 2010 and May 2011 by submitting false and fraudulent claims. According to the indictment, Heilbron allegedly executed his fraudulent scheme by:
- 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;
- Inserting false symptoms, observations, and diagnoses into patients’ medical charts to provide written support for the tests he ordered or performed;
- Inserting 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;
- Submitting the photocopied notes, results, and images to the insurance plans when the plans requested documentation to support the claims submitted;
- Submitting claims to health plans for procedures that were never performed;
- Submitting claims for procedures performed on two consecutive dates to increase the amount paid for services that were actually rendered together on one single date; and
- Misusing billing codes and modifiers in order to increase his rate of reimbursement.
Counts 1 through 9 of the indictment allege that Heilbron committed health care fraud by submitting false claims for medical services rendered to health care benefit programs on nine dates between July 13, 2010 and Feb. 10, 2011. Counts 10-21 allege that Heilbron committed health care fraud by submitting falsified medical records for medical services to health care benefit programs on twelve occasions between Jan. 20, 2010 and May 5, 2011. Counts 22 through 24 allege that Heilbron committed wire fraud by using wire communications to obtain payments from health care benefit programs.
The indictment includes forfeiture provisions that seek forfeiture of any property derived from the proceeds of the crimes charged in the indictment.
If convicted on the health care fraud charges, Heilbron faces a statutory maximum penalty of ten years in prison. If convicted on the wire fraud charges, Heilbron faces a statutory maximum penalty of 20 years in prison. Maximum potential sentences are prescribed by Congress and are provided for informational purposes only. The sentence to be imposed on a defendant is determined by the court.
Charges in indictments are merely accusations and defendants are presumed innocent unless found guilty beyond a reasonable doubt.
This case was investigated by the Santa Fe and Albuquerque offices of the FBI and is being prosecuted by Assistant U.S. Attorney C. Paige Messec.