Silver Spring woman sentenced for health care fraud

A Silver Spring woman who pleaded guilty in a health care fraud case will have to spend six months in home confinement and pay back more than $150,000.

Rosemary McDowall, 59, was sentenced in federal court in Greenbelt on Thursday to 18 months of probation — six of those months in home confinement, according to a statement from the U.S. Attorney’s Office for Maryland.

She pleaded guilty in the case on March 29.

McDowall had been working as a licensed social worker, and began working with Blue Cross Blue Shield of Maryland in 1996 as a “participating provider,” meaning she would submit claims to, and be paid by, Blue Cross. Her contract required that she notify Blue Cross if she lost her license, according to the statement.

Teresa Whalen, her attorney, said that McDowall was a person who contributed to her community and who had received dozens of letters of support since her arrest.

Whalen said her client’s behavior had been an “aberration,” and that McDowall had made a mistake by not reapplying to have her license reinstated after the suspension.

“Very early on, she accepted responsibility, and attempted to work out paying back Blue Cross Blue Shield,” Whalen said.

Maryland authorities suspended McDowall’s license in 2005, but she did not notify Blue Cross, and continued seeing patients and submitting claims for payment, according to the statement.

Then, in 2008, after Blue Cross terminated its contract with McDowall, she continued working as a “non-participating provider,” meaning her patients paid her directly, but could be reimbursed by Blue Cross. Even though her license had been suspended, she kept seeing patients and submitting payment claims to Blue Cross, the Attorney’s Office statement noted.

Five years after McDowall was suspended and was not a licensed social worker, Blue Cross finally found out about the scheme and stopped paying the claims. In total, McDowall ended up defrauding Blue Cross between $120,000 and $200,000, according to the statement. Whalen and McDowall had asked for a sentence that would keep McDowall out of jail and allow her to repay the money.

“I think the judge recognized she was otherwise a stellar member of the community,” Whalen said, speaking of the sentence.

“She’s been living with this since 2010. She’s relieved. She’s ready to move forward with her life,” Whalen said.

Calls to McDowall’s home were not answered.

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