SANTA ANA, Calif. – A man banned for life from California’s workers’ compensation system after being twice convicted of workers’ compensation insurance fraud has been charged along with a San Diego-based neurosurgeon and two other co-conspirators in connection with billing nearly $100 million in fraudulent fees as part of an extensive workers’ compensation fraud scheme.
The charges follow a three-year investigation by the Orange County District Attorney’s Office into twice convicted felon David Fish who is accused of continuing to control clinics and providers who would see patients, refer them to specific providers in order to receive illegal referral payments, and then unlawfully bill workers’ compensation insurance companies for these services.
Fish, 55 of Laguna Niguel, Martin Brill, 78 of Los Angeles, and Robert Lee, 61 of Rancho Mirage, formed Southern California Injured Workers (SCIW), a management company which offered medical management services, including marketing, billing, and collections. Fish worked for the company as a “consultant,” but exercised complete control over the operation.
These three codefendants, along with San Diego neurosurgeon Dr. Vrijesh Tantuwaya, also created a medical group called Injured Workers Medical Group (IWMG), which was the main client for SCIW. Dr. Tantuwaya was named the owner and CEO of this medical professional corporation.
The four co-defendants have been charged with 13 separate felony counts which include violations of Labor Code 3215 (referral of clients for compensation), Penal Code 182(a)(1) (conspiracy to commit a crime), Penal Code 549 (false and fraudulent claim) and Penal Code 550 (b)(3) (insurance fraud).
Using the medical group, SCIW controlled patient referrals to a limited network of providers which contracted with SCIW to pay for the patient referrals. In three years, these defendants billed nearly $100 million dollars to numerous workers’ compensation insurance carriers, and were illegally paid referral fees from providers of services such as diagnostic testing and compound pharmacies.
“The Orange County District Attorney’s Office remains fiercely committed to prosecuting bad actors who exploit the workers’ compensation system to line their own pockets rather than helping injured workers,” said Orange County District Attorney Todd Spitzer. “At a time when families across America are struggling to keep up with increasing prices for everything from gas and rent to just being able to put food on the table for their families, criminals like these only increase the cost of insurance premiums and put the American dream just that much further out of reach for so many hardworking people. I am incredibly proud of the men and women of our Insurance Fraud team and their continued dedication to fighting for the rights of workers.”
According to the Coalition Against Insurance Fraud, insurance fraud is responsible for more than $308.6 billion in theft every year from American consumers. The California Department of Insurance reports that insurance fraud totals $17.2 billion each year and costs California residents an average of $440 a year through higher premiums, higher taxes, and higher prices. Investigating and prosecuting this fraud benefits all Californians.
If convicted, Fish faces maximum sentence of 18 years and four months in prison. Brill faces maximum of 12 years and four months in prison, Tantuwaya faces 13 years, four months in state prison and Lee faces 12 years and four months in prison.
Deputy District Attorney Kelly Albright of the Insurance Fraud Unit is prosecuting this case.
