Charges filed in $100 million fraud scheme

A man already banned for life from California’s workers compensation system after being twice convicted of 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 in Santa Ana, California, into felon David Fish, who is now 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 compensation insurance companies for these services.

Mr. Fish, of Laguna Niguel, California, Martin Brill, of Los Angeles, and Robert Lee, of Rancho Mirage, California, formed Southern California Injured Workers, a management company known as SCIW that offered medical management services, including marketing, billing, and collections. Mr. Fish allegedly worked for the company as a consultant, but exercised complete control over the operation, according to the district attorney’s office.

These three codefendants, along with San Diego neurosurgeon Dr. Vrijesh Tantuwaya, also created a medical group called Injured Workers Medical Group, which was the main client for SCIW. Dr. Tantuwaya was named the owner and CEO of this medical professional corporation and has also been charged.

The men have been charged with 13 felony counts, mostly related to insurance fraud, alleging they billed nearly $100 million to numerous workers compensation insurers, and were illegally paid referral fees from providers of services such as diagnostic testing and compound pharmacies.