In a major California workers’ compensation case, authorities have charged an Orange County man who was twice convicted of fraud, along with a San Diego neurosurgeon and two others, for allegedly charging nearly $100 million in fraudulent fees.
After a three-year investigation, the Orange County District Attorney’s Office said Friday that David Fish, 55, of Laguna Niguel, was allegedly behind a massive scheme “to control medical clinics and providers who would see patients, refer them to specific providers in order to receive illegal referral payments, and then illegally bill workers’ compensation insurance companies for these services.
Workers’ compensation fraud is estimated at $30 billion a year in the United States, and California employers have long complained about the high cost of insurance premiums to cover employees against workplace injuries. A common system in so-called medical factories is to encourage workers to seek medical treatment from specific doctors.
“At a time when families across America are struggling to cope with rising prices for everything from gas and rent to simply being able to put food on the table for their families , criminals like these only drive up the cost of insurance premiums and put America at risk. a dream even further out of reach for so many hard-working people,” said Orange County Dist. Atty. Todd Spitzer.
Benjamin N. Gluck, Fish’s Los Angeles lawyer, said the accusations were unfounded.
“The Orange County District Attorney’s Office has a history of filing similar complaints, but these collapse under scrutiny,” Gluck said. “We believe this case will be just another case in this line.”
Spitzer’s office also named two co-conspirators Friday — Martin Brill, 78 of Los Angeles, and Robert Lee, 61 of Rancho Mirage — alleging they formed a company, Southern California Injured Workers, that provided medical management, including marketing, billing and collections. . In fact, the company was entirely controlled by Fish, authorities said.
The three co-defendants, along with San Diego neurosurgeon Dr. Vrijesh Tantuwaya, also established a medical group called Injured Workers Medical Group, which was the primary client of injured workers in Southern California. Tantuwaya was named owner and CEO of this medical professional corporation, Spitzer’s office said.
The four men were charged with 13 separate counts, including violations related to referring clients for hire, conspiracy to commit a crime and insurance fraud.
Scott A. Simmons, an Irvine-based attorney for Tantuwaya, said in a statement that his client “maintains his complete innocence and is confident that the evidence will demonstrate his lack of involvement in illegal activities.”
“Dr. Tantuwaya is a respected and highly skilled neurosurgeon, with an unblemished career spanning 22 years,” Simmons said. “Records will show that Dr Tantuwaya did not receive a single penny in bribes. It will become clear that he himself was a victim of fraud and has in fact filed a civil suit against injured Southern California workers.
Attorneys for Brill and Lee could not immediately be reached for comment.
Simmons said his client, Tantuwaya, and the three other men all pleaded not guilty and were released on bail.
If convicted, Fish faces a maximum sentence of 18 years and four months in prison; Brill, a maximum of 12 years and four months in prison; Tantuwaya, 13, four months in state prison; and Lee, 12 years and four months in prison.
According to the OC District Attorney’s Office, Fish has two prior convictions for workers’ compensation fraud. This included a 2010 conviction for compensating or inducing the referral of clients who went to favored medical providers to charge high bills.
In December 2017, the California Department of Industrial Relations barred Fish from participating in the state’s workers’ compensation system.
