Silver Spring Woman Pleads Guilty to Health Care Fraud

A Silver Spring woman and former social worker pleaded guilty to health care fraud last week for causing a health insurance company to continue making payments for patients she saw after her license had been suspended, the U.S. Attorney's office for the District of Maryland announced. 

Rosemary McDowall, 59, pleaded guilty to the fraud on March 29 admitting that she continued to see patients insured by Blue Cross Blue Shield of Maryland after her license to practice social work was suspended in 2005 by the state's social work regulatory board for numerous violations.

She failed to notify the insurance company of that suspension—as required by her contract with BCBS— and admitted that fraudulent claims totaling between $120,000 and $200,000 were submitted.

McDowall will be sentenced on July 8 and faces up to 10 years in prison and a fine of $250,000. McDowall's plea agreement requires her to pay full restitution.

Under her contract with BCBS as a participating provider, McDowall was obligated to accept payments directly from the insurance company. After 2005 and her license suspension, McDowall not only continued to see patients but she also caused claims to be submitted to BCBS, the U.S. Attorney’s office said.

In 2008, BCBS terminated McDowall as a participating provider but she continued as a non-participating provider with the insurance company.  This allowed her to collect fees from patients and then BCBS reimbursed the patients the allowed amount.

In 2010, BCBS discovered that McDowall’s license had been suspended in 2005.  The insurance company stopped paying claims submitted by McDowall and of the BCBS members who saw her for treatment.

According to online records of the Maryland State Board of Social Workers, McDowall was investigated in April 2003 after a former patient alleged that the social worker had an improper relationship with the patient. 

Among the allegations against McDowall were borrowing money (and failing to pay it back), disclosing personal and family details to the patient, violating patient and social worker confidentiality, and misrepresenting herself as a clinical social worker even though she was not licensed in psychology.