A physical therapist who had offices in Shenango Township and Ellwood City is in a Cumberland County state prison serving a sentence for insurance fraud.
Detectives of the Cumberland County district attorney's office had filed charges against Timothy P. Burke, 55, of Poland, Ohio, owner of Burk Physical Therapy and Rehabilitation, and James F. "Frank" Mars, 44, of Portersville, last October.
Burk and Mars both pleaded guilty last month in Cumberland County Common Pleas Court and were sentenced on Sept. 15.
Burk's plea was to a felony count of insurance fraud. He was sentenced to six to 23 months in the Cumberland jail. He also is ordered to pay a $15,000 fine, plus court costs.
Mars pleaded guilty to one count of receiving stolen property and was sentenced to a year of probation. He is ordered to pay a $2,500 fine plus court costs.
Other charges against them related to the case were dismissed as part of their plea agreements.
According to information from the Cumberland County district attorneys' office criminal investigation division and insurance fraud section, the investigation into Burk's insurance practices began three years ago and involved his office locations at 1677 Ellwood Road, Ellwood City (Slippery Rock Township) and at 2610 Ellwood Road, in Lawrence Village Plaza in Shenango Township.
Investigators learned that Burk's practice had been fraudulently billing Highmark insurance for athletic training, and submitting the claims as physical therapy services.
Both Burk and Mars also instructed and supervised staff to create false records to support billing of services they knew to be fraudulent, according to papers filed in court. The investigation also revealed that Burk Physical Therapy consistently overbilled for services it was legitimately providing, including aquatic therapies, for patients.
A criminal complaint filed against both men indicates that Mars was managing the business and conducting the company's day-to-day operations.
A former worker told investigators that athletic trainers were providing various training to students, that was billed to insurers as physical therapy. The firm providing the athletic training did not have licensed physical therapists or physical therapy assistants, the paperwork states.
Investigators served search warrants at the company's locations in Ellwood City and Shenango Township in 2017, and confiscated 966 files of patients who were Highmark members.
The Cumberland County agents conducted multiple interviews with office staff and patients at the two rehabilitation centers, and determined that Burk and Mars directly facilitated the fraudulent billing activities, the criminal complaint states. It states that both men instructed physical therapists to approve insurance billing and create documents to substantiate false claims for patients who were seen by the athletic performance trainers, the report says, and they also directed office staff in fraudulent over-billing of aquatic therapies conducted by unlicensed providers.
The paperwork states that between Jan. 1, 2014 and April 28, 2017, Burk Physical Therapy fraudulently billed aquatic therapy 4,722 times for a total payment of $248,709 from Highmark. Over-billing from other accounts totaled $75,653 for services not rendered, according to the complaint.
In total, Burk Physical Therapy had billed Highmark for $2,896,410 for services that were fraudulent, and received $1,119,299 for the services, the report states.
Burk and Mars both were arrested and charged in October 2019.
The information notes that Burk, as of Tuesday, is still listed through the Department of State's corporations bureau as the president, vice president, secretary and treasurer of the business. He also operated a practice in Monaca, Beaver County.