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Patient billing supervisor pleads guilty to fraud

September 24, 2012

St. Louis, MO - Pamela Hoernschemeyer pled guilty to bank fraud charges involving her fraud as an insurance billing supervisor handling the SSM Health Care account.

SSM Health Care (SSM) is a health care organization, sponsored by the Franciscan Sisters of Mary, that operates hospitals, nursing homes and physician practices in four Midwestern States. Lackland Acquisition II, LLC, d/b/a Healthcare Strategic Initiatives (HSI) and operating as Nextgen Healthcare contracted with SSM for patient billing and collections, claims submissions, remittance and payment posting and account management. HSI has its corporate offices in St. Louis. Pamela Hoernschemeyer was employed by HSI as a supervisor, and was in charge of the SSM account.

According to court documents, on many occasions, Hoernschemeyer submitted fraudulent check request forms to SSM requesting that SSM issue a refund check to a purported patient. The names of these purported patients were variations of Hoernschemeyer’s own name, as well as variations of both her husband and daughter’s names. As a result of this fraudulent activity SSM issued checks to the purported patients under the false names that she had provided, and she deposited the checks into several different personal accounts. Through her fraudulent conduct, she obtained in excess of $100,000 which she used for personal purchases and spending.

Additionally, following her indictment, she submitted false and forged documents to the Court, falsely representing that her current employer was aware of the pending bank fraud charges as required by the Court’s bond conditions. Her bond was revoked and she remains in the custody of the U.S. Marshal.

PAMELA HOERNSCHEMEYER, St. Peters, MO, pled guilty to three felony counts of bank fraud before United States District Judge Carol E. Jackson. Sentencing has been set for December 27, 2012.

Each count of bank fraud carries a maximum penalty of 30 years in prison and/or fines up to $1 million. In determining the actual sentences, a Judge is required to consider the U.S. Sentencing Guidelines, which provide recommended sentencing ranges.

This case was investigated by the Postal Inspection Service. Assistant United States Attorney Hal Goldsmith is handling the case for the U.S. Attorney’s Office.

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