Former social worker sentenced for health care fraud

Trial Gavel Verdict Former social worker sentenced for health care fraudGREENBELT – A former Silver Spring social worker is in hot water after being sentenced for health care fraud.

On Thursday, U.S. District Judge Roger W. Titus sentenced Rosemary McDowall, 59, to six months of home detention as part of 18 months’ probation, for health care fraud. McDowall was also ordered 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 Blue 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 had been suspended, and she continued to see patients. 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.

Despite the fact that her license to practice 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 her or by BCBS members who had seen her for treatment. McDowall admitted that fraudulent claims submitted during the scheme total between $120,000 and $200,000.

Rosenstein praised the FBI for its work in the investigation.

 Former social worker sentenced for health care fraud

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