Government Actions against
Roy G. Heilbron, M.D.
Stephen Barrett, M.D.
Roy G. Heilbron, M.D., who has practiced cardiology in New Mexico and Florida, has been disciplined by both states. In March 2014, as shown below, the New Mexico Medical Board indicated that it intended to discipline him for failing to notify the board within 30 days that (a) he had been arrested for driving under the influence of alcohol and (b) Blue Cross Blue Shield had terminated his provider agreement for "excessive, unjustified and fraudulent billing practices." The matter was settled in June 2014 with a stipulated order under which his license was suspended for three months and he was required to complete courses in ethics and recordkeeping. In June 2015, after Heilbron failed to notify the Florida Medical Board on time, the Florida board issued a letter of concern and assessed a $5,000 fine plus $1,234 in costs. In July 2015, he was charged with health care fraud and wire fraud that involved submitting false and fraudulent claims to Medicare, Blue Cross Blue Shield, and other health insurers in 2010 and 2011. The indictment charges that he:
- 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
- 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
- Submitted the photocopied notes, results, and images to the insurance plans when the plans requested documentation to support the claims submitted
- Submitted claims to health plans for procedures that were never performed
- 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
- Misused billing codes and modifiers in order to increase his rate of reimbursement
Heilbron has co-chaired the chelation therapy workshops for the American College for Advancement in Medicine (ACAM), the primary organization that advocates the use of chelation for cardiovascular disease and other questionable purposes.
BEFORE THE NEW MEXICO MEDICAL BOARD
IN THE MATTER OF
License No. MD2006-0145
NOTICE OF CONTEMPLATED ACTION
YOU ARE HEREBY NOTIFIED that pursuant to provisions of Section 61-1-4 NMSA 1978 of the Uniform Licensing Act ("ULA"), the New Mexico Medical Board ("Board") has before it sufficient evidence that, if not rebutted or explained, will justify the Medical Board imposing sanctions that could include restricting, revoking or suspending your license to practice medicine in the State of New Mexico.
1. You are subject to action by the Board pursuant to Sections 61-1-1 et seq. NMSA 1978 of the Uniform Licensing Act and Sections 61-6-1 et seq., NMSA 1978 of the Medical Practice Act.
This contemplated action is based on the following allegations:
A. On or about April 20, 2013, you were arrested in Albuquerque, New Mexico and charged with aggravated DWI. You failed to report this arrest to the Board as required by Rule 22.214.171.124 NMAC.
B. By letter dated March 15, 2011, the health care insurance company Blue Cross Blue Shield ("BCBS") took adverse action against you, terminating your Medical Services Entity Agreement. BCBS held an informal "Fair Hearing" on May 2, 2011, which affirmed the initial decision to terminate the agreement.
C. The bases for the action in B, above, was your excessive, unjustified and fraudulent billing practices for numerous patients that were insured by BCBS.
D. You reported the action in B, above, in your renewal application submitted in June 2012, not within 30 days as required by Rule 126.96.36.199 NMAC.
3. These allegations, if proven, would constitute a violation of the following sections of the Act:
- Section 61-6-15(D)(33), failure to maintain or keep adequate, legible, accurate or complete medical records;
- Section 61-6-15(D)(4), obtaining a fee by fraud or misrepresentation;
- Section 61-6-15(D)(15), the use of a false, fraudulent, or deceptive statement in a document connected with the practice of a licensee;
- Section 61-6-15(D)(18), conduct likely to deceive or defraud the public; and
- Section 61-6-15(D)(21)(c), failure to report to the Board any adverse action against the licensee by a health care entity.
4. Please take notice that pursuant to Section 61-1-4, you may secure a hearing before the Board by depositing in the mail within twenty (20) days after service of this notice a certified return receipt requested letter addressed to the Board and containing a request for a hearing. If you do not request a hearing within twenty (20) days after service of this notice as described above, the Board will take the contemplated action, i.e., imposing sanctions that could include the revocation or suspension of your license to practice medicine in the State of New Mexico, and there will be no judicial review of their decision.
5. Pursuant to Section 61-1-8 NMSA 1978, you have the right to be represented by counselor by a licensed member of your profession or both, and to present all relevant evidence by means of witnesses, books, papers, documents and other evidence; to examine all opposing witnesses who may appear on any matter relevant to the issues and have subpoenas duces tecum issued as of right prior to the commencement of the hearing, to compel the attendance of witnesses and the production of relevant books, papers, documents and other evidence upon making a written request with the discretion of the Board or Hearing Officer.
6. The issuance of this Notice of Contemplated Action is not a disciplinary event reportable to any data bank but is a public document open to public inspection.
7. In the event that the Board takes a final action against you as specified in Section 61-1-3 of the ULA, you shall bear all costs of disciplinary proceedings pursuant to Section 61-1- 4(G) of the ULA unless excused by the Board.
Dated this 11th day of March, 2014.
NEW MEXICO MEDICAL BOARD
Lynn Hart, Executive Director
NM Medical Board
2-55 S. Pachedco, #400
Santa Fe, New Mexico 87505
This page was posted on September 24, 2015.