A judge sentenced a Santa Fe, N.M.-based physician to more than four years in prison for healthcare billing fraud and obstruction of justice after he allegedly faked a cancer diagnosis to postpone the hearing, according to the Albuquerque Journal.
A federal grand jury indicted self-described “holistic” cardiologist Roy G. Heilbron, MD, in 2015 with health care fraud and wire fraud. The indictment alleged that Heilbron executed a scheme to defraud Medicare and other health care benefit programs from January 2010 to May 2011 by submitting false and fraudulent claims. The indictment alleged that Heilbron used photocopies of patients’ records to fabricate records for others. For more than 100 patients, he reported identical results for various ultrasound tests, heartbeats per 24 hours and hypertension, the indictment said.
The indictment alleged Heilbron also:
• Performed and billed for a wide array of unnecessary tests on every new patient and submitted false diagnoses with the billing claims to justify the tests to the insurance plans.
• Inserted false symptoms, observations, and diagnoses into patients’ medical charts to provide written support for the tests he ordered or performed.
• Submitted claims to health plans for procedures that were never performed and for procedures performed on two consecutive dates to increase the amount paid for services that were actually rendered together on one date.
• Misused billing codes and modifiers to increase his rate of reimbursement.
The wire fraud counts maintained that he used “wire communications” to obtain improper payments from health care benefit programs. The indictment included provisions that sought forfeiture of any property derived from the proceeds of the crimes charged in the indictment, according to the statement from the U.S. Attorney’s Office.
In February 2017, Dr. Heilbron pleaded guilty to fraud and admitted his Santa Fe-based clinic defrauded Medicare, Blue Cross and Blue Shield of New Mexico, and other health insurers. Last year the New Mexico medical board banned him from reapplying to practice medicine in the state.
Dr. Heilbron’s obstruction count alleged that he faked medical documents purportedly showing he had cancer and was seeking chemotherapy in Costa Rica. He claimed a delay in treatment could result in his death. Authorities arrested Dr. Heilbron in August 2017, after determining the documents were fake and may have been used to postpone or avoid his fraud sentencing. Dr. Heilbron pleaded guilty to the obstruction count in February 2018, admitting he was vacationing in Europe when he requested to postpone his sentencing.