A man banned for life from the California workers’ compensation system after being twice convicted of fraud was charged with billing nearly $100 million as part of an extensive workers’ comp fraud scheme.
David Fish was charged along with a San Diego-based neurosurgeon and two other co-conspirators in connection with the scheme.
The charges follow a three-year investigation by the Orange County District Attorney’s Office into Fish, who is accused of continuing to control clinics and providers who would see patients, refer them to specific providers to receive illegal referral payments and then unlawfully bill workers’ comp insurers.
Fish, 55 of Laguna Niguel, Martin Brill, 78 of Los Angeles, and Robert Lee, 61 of Rancho Mirage, formed Southern California Injured Workers, a management company that offered medical management services.
The codefendants, along with San Diego neurosurgeon Dr. Vrijesh Tantuwaya, also created a medical group called Injured Workers Medical Group, the main client for SCIW. Dr. Tantuwaya was named the owner and CEO of the medical professional corporation.
Using the medical group, SCIW reportedly controlled patient referrals to a limited network of providers which contracted with SCIW to pay for the patient referrals. In three years, the defendants reportedly billed nearly $100 million dollars to numerous workers’ comp carriers, and were illegally paid referral fees from providers of services such as diagnostic testing and compound pharmacies.
The four were 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).
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 the case.
Topics California Workers' Compensation
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