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Former Social Worker Gets 6 Months in Health Care Scam
Greenbelt, Maryland – Rosemary McDowall, a 59-year-old Silver Spring woman, was sentenced to six months of home detention as part of 18 months probation, for her role in a $151,404.73 health care fraud scheme. Judge Roger W. Titus handed down the sentence, which also includes restitution of $151,404.73.
According to her plea agreement, in 1996, McDowall 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. However, 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. BCBS terminated McDowall as a participating provider in 2008, but permitted her to continue to be a non-participating provider with BCBS.
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. McDowall admitted that fraudulent claims submitted during the scheme total between $120,000 and $200,000.
United States Attorney Rod J. Rosenstein praised the Federal Bureau of Investigation 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.
The sentence is a result of an investigation by the Federal Bureau of Investigation. The case was prosecuted by Assistant U.S. Attorneys Mara Zusman Greenberg and Kristi N. O’Malley.
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Key Facts
- State: Maryland
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release ↗
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