Former Social Worker Sentenced to Prison for Health Care Fraud
Continued to Practice After Her LIcense was Suspended in 2005
|U.S. Attorney’s Office September 19, 2013|
GREENBELT, MD—U.S. District Judge Roger W. Titus sentenced Rosemary McDowall, age 59, of Silver Spring, Maryland, today to six months of home detention as part of 18 months’ probation for health care fraud. Judge Titus also ordered McDowall to pay restitution of $151,404.73.
The sentence was announced by United States Attorney for the District of Maryland Rod J. Rosenstein and Special Agent in Charge Stephen E. Vogt of the Federal Bureau of Investigation.
According to her plea agreement, in 1996, McDowall, a licensed social worker, signed a contract to become a participating provider with Blue Cross Blues Shield of Maryland (BCBS). As a participating provider, McDowall was entitled to accept payment directly from BCBS for services rendered. Under the terms of her contract, McDowall was obligated to notify BCBS if she lost her license to practice as a social worker.
In 2005, McDowall’s license to practice as a social worker was suspended by the Maryland State Board of Social Work Examiners. McDowall failed to report to BCBS that her license to practice was suspended, as was required under her contract, and she continued to see patients and caused claims to be submitted to BCBS. In 2008, still unaware that McDowall’s license had been suspended, BCBS terminated McDowall as a participating provider but permitted her to continue to be a non-participating provider with BCBS. BCBS participating providers send claims to and are paid directly by BCBS. Patients of BCBS non-participating providers must pay the provider directly, and the patients are reimbursed by BCBS the allowed amount of their claim. Despite the fact that her license to practice social work had been suspended, McDowall continued to submit claim forms to BCBS for the patients she treated. BCBS reimbursed McDowall’s patients the allowed amount, and McDowall collected her allowed fees from the patient.
In 2010, BCBS learned that McDowall had not been licensed to practice social work since 2005 and stopped paying all claims submitted by McDowall or BCBS members who had seen McDowall for treatment. McDowall admitted that fraudulent claims submitted during the scheme total between $120,000 and $200,000.
United States Attorney Rod J. Rosenstein praised the FBI for its work in the investigation. Mr. Rosenstein thanked Assistant U.S. Attorneys Mara Zusman Greenberg and Kristi N. O’Malley, who prosecuted the case.