A 55-year-old Laguna Niguel man, twice convicted of insurance fraud and banned for life from California’s workers’ compensation system, faces new charges alleging he and three others billed nearly $100 million in fraudulent fees as part of an extensive workers’ compensation scheme, authorities said on Friday, Oct. 11.
For three years, authorities investigated David Fish before accusing him 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,” the Orange County District Attorney’s Office said in a statement.
Also charged were Martin Brill, 78, of Los Angeles and Robert Lee, 61, of Rancho Mirage. The two men allegedly worked with Fish to form Southern California Injured Workers, which offered medical-management services, including marketing, billing and collections, officials said.
Fish was labeled as a consultant, but prosecutors accused him of controlling the operation.
Dr. Vrijesh Tantuwaya, a San Diego-based neurosurgeon, was also charged and accused of working with the men and creating the Injured Workers Medical Group, the main client for Fish’s management company, prosecutors said.
Southern California Injured Workers controlled referrals to contracted providers, billed multiple workers’ compensation insurance carriers and received illegal payments from service providers for diagnostic testing and compound pharmacies, prosecutors said.
Fish faces two counts of conspiracy, two counts of referring clients for compensation and eight counts of insurance fraud, according to court records.
Brill and Lee each face one count of conspiracy and eight counts of insurance fraud. Tantuwaya is accused of one count of conspiracy, one count of false or fraudulent claim, and eight counts of insurance fraud.
The four defendants have all pleaded not guilty and been released on bail, court records show.
“At a time when families across America are struggling to keep up with the 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 farther out of reach for so many hardworking people,” Orange County District Attorney Todd Spitzer said in a statement.
The men all face more than a decade in prison if convicted as charged, prosecutors said. It was not known whether the defendants had attorneys who would comment on their behalf.
Insurance fraud raises premiums and taxes for others. The California Department of Insurance, the DA’s Office says, has determined that such fraud costs Californians an average of $440 annually.
“Investigating this fraud benefits all Californians,” DA officials said in their statement.
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