Roy G. Heilbron Also Ordered to Pay $623,477.25 in
Restitution
ALBUQUERQUE – Chief U.S. District Judge William P. “Chip”
Johnson sentenced Roy G. Heilbron in federal court in Albuquerque, N.M., this
afternoon to 51 months of imprisonment for his convictions on health care fraud
and obstruction of justice charges. The
sentence was announced by U.S. Attorney John C. Anderson, Acting Special Agent
in Charge Maxwell D. Marker of the FBI’s Albuquerque Division, and U.S. Marshal
Sonya K. Chavez.
Heilbron, 54, a cardiologist residing in Santa Fe, N.M., was
sentenced to 24 months for his conviction on a health care fraud charge, and 27
months for his conviction on an obstruction of justice charge arising out of
his attempt to obstruct and impede sentencing proceedings on the health care
fraud case. Heilbron was ordered to
serve the two sentences consecutively for an aggregate of 51 months of
imprisonment. Heilbron will be on
supervised release for three years after completing his prison sentence. Heilbron also was ordered to pay $623,477.25
in restitution to the victims of his health care fraud crimes.
A federal grand jury indicted Heilbron in June 2015, and
charged him with health care fraud and wire fraud offenses. The 24-count indictment charged Heilbron, a
physician who was then licensed to practice medicine in New Mexico who
specialized in cardiology, with executing 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 health care fraud indictment, Heilbron executed his 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.
On Feb. 17, 2017, Heilbron pled guilty to one count of
health care fraud. In his plea
agreement, Heilbron acknowledged that at all times relevant to the crimes
charged in the indictment, he was a doctor involved in the private practice of
medicine. Heilbron further admitted from
Dec. 2009 through Dec. 2011, he provided medical services as A Well for Health
Church, Inc., a medical clinic in Santa Fe, where he contracted with several
health care benefit programs including Blue Cross and Blue Shield of New Mexico
and Medicare. Under the terms of those
contracts, Heilbron would bill the programs for medical services he provided to
patients covered by those programs and included his medical diagnosis or other
justifications for the services for which he requested compensation. In his plea agreement, Heilbron admitted
devising and executing a scheme to deceive and obtain money from health care
programs that covered his patients by misrepresenting his patients’ diagnoses.
On Aug. 7, 2017, Heilbron’s attorney filed a motion to
continue Heilbron’s sentencing hearing on the health care fraud charge, which
was then scheduled for Aug. 28, 2017, to permit Heilbron to begin chemotherapy
in Costa Rica for prostate cancer. The
motion included two attachments: a
one-page “Treatment Protocol for Roy Heilbron” dated Aug. 3, 2017, which
purported to detail Heilbron’s alleged prostate cancer diagnosis, and a
three-page “Clinical Summary” dated June 24, 2017, which purported to outline a
four-cycle chemotherapy treatment plan.
The two documents purported to be authored by a physician with offices
in San Jose, Costa Rica, and Miami, Fla.
On Aug. 9, 2017, a U.S. Magistrate Judge issued a warrant
for Heilbron’s arrest based on a criminal complaint charging him with making
and presenting fraudulent documents regarding his medical condition to a U.S.
Probation Officer, and submitting the fraudulent documents for the purpose of
postponing or avoiding sentencing in the pending health care fraud
prosecution. The complaint outlined the
FBI’s investigation into the claims made in the “Clinical Summary” and “Treatment
Protocol,” and asserted that Heilbron created the two documents himself and
that Heilbron was not a patient of the physician whose name appears on the
fraudulent documents. According to the
complaint, Heilbron provided the fraudulent documents to his U.S. Probation
Officer on Aug. 4, 2017, in support of a request to postpone his sentencing
hearing. Heilbron was subsequently
charged on Sept. 6, 2017, in a two-count indictment setting forth the same
charges as those contained in the complaint.
The indictment alleged that Heilbron committed the two crimes in
Bernalillo County, N.M., and elsewhere, between Aug. 3, 2017 and Aug. 7, 2017.
On Feb. 2, 2018, Heilbron entered a guilty plea to the
obstruction of justice charge of the indictment. In his plea agreement, Heilbron acknowledged
that he previously pled guilty to a health care fraud charge on Feb. 17, 2017,
and had a sentencing hearing on Aug. 28, 2017.
Heilbron also admitted that on Aug. 4, 2017, he sent his Probation
Officer an email requesting to postpone his sentencing hearing based on the
representation that he was scheduled to begin chemotherapy treatments in Costa
Rica on Aug. 14, 2017. In support of his
request, Heilbron attached a clinical summary and treatment protocol
purportedly authored by Heilbron’s physician.
Heilbron admitted that the email was false and created for the purpose
of delaying or avoiding the sentencing hearing on his health care fraud plea,
and at the time he made the request for the postponement, he was on vacation in
Europe with no intention of beginning chemotherapy treatments in Costa Rica
beginning on Aug. 14, 2017.
In entering the guilty plea, Heilbron acknowledged that when
he sent the false email, he was on release under a July 1, 2015 order of the
U.S. District Court for the District of New Mexico relating to his health care
fraud charge that put him on notice of the effect of committing crimes while on
presentence release.
The obstruction of justice case was investigated by the
Santa Fe and Albuquerque offices of the FBI, with assistance from the Charlotte
office of the FBI and the U.S. Marshals Service, and the Santa Fe office of the
FBI investigated the health care fraud case.
Assistant U.S. Attorneys George C. Kraehe, Jeremy Peña and Paige Messec
prosecuted the cases.
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