US: Former social worker pleads guilty to health care fraud
A 59-year-old former social worker named Rosemary McDowall of Silver Spring, Maryland pleaded guilty on Friday to health care fraud.
The guilty plea 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 obligated to accept payment for services rendered directly from BCBS.
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 for numerous violations.
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, BCBS terminated McDowall as a participating provider, but McDowall continued to be a non-participating provider with BCBS and was permitted to collect her allowed fees from the patient and then BCBS would reimburse the patient the allowed amount.
Despite the fact that her license to practice social work had been suspended, McDowall continued to see patients and submitted claim forms to BCBS.
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 USD 120,000 and USD 200,000.
McDowall faces a maximum sentence of 10 years in prison and a fine of USD 250,000 for health care fraud.
As part of her plea agreement, McDowall will be required to pay restitution in the full amount of the loss. U.S. District Judge Roger W. Titus scheduled sentencing for July 8 at 3:00 p.m.
United States Attorney Rod J. Rosenstein praised the FBI for its work in the investigation. Rosenstein thanked Assistant U.S. Attorneys Mara Zusman Greenberg and Kristi N. O'Malley, who are prosecuting the case.
(Posted on 30-03-2013)