In a significant California workers’ compensation insurance case, investigators charged an Orange County man who was twice convicted of fraud, as well as a San Diego neurosurgeon and two others, with allegedly charging over $100 million in false payments.
Following a three-year investigation, the Orange County district attorney’s office announced on Friday that David Fish, 55, of Laguna Niguel, allegedly masterminded an extensive scheme “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.”
Workers’ compensation fraud is considered to be a $30 billion annual problem in the United States, and California firms have long complained about the high cost of insurance premiums to cover employees for work-related injuries. One prevalent method at so-called medical mills is to direct workers to seek medical treatment from specific doctors.
“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,” said Todd Spitzer, the district attorney for Orange County.
Fish’s attorney in Los Angeles, Benjamin N. Gluck, said the charges are false.
“The Orange County District Attorney’s Office has a history of filing similar cases only to have them collapse under scrutiny,” Mr. Gluck said. “We think this case will be just one more in that line.”
Spitzer’s office also named two co-conspirators on Friday: Martin Brill, 78, of Los Angeles, and Robert Lee, 61, of Rancho Mirage. They are accused of forming Southern California Injured Workers, which provided medical management services such as marketing, billing, and collections. According to authorities, Fish was solely responsible for running the company.
The three co-defendants, along with San Diego neurosurgeon Dr. Vrijesh Tantuwaya, founded Injured Workers Medical Group, which was the primary customer of Southern California Injured Workers. According to Spitzer’s office, Tantuwaya has been designated as the owner and CEO of this medical professional corporation.
The four individuals have been charged with 13 separate criminal offenses, including infractions involving customer referrals for payment, conspiracy to commit a crime, and insurance fraud.
Tantuwaya’s attorney, Scott A. Simmons of Irvine, said in a statement that his client “maintains his complete innocence and is confident that the evidence will demonstrate his lack of involvement in any illegal activities.”
“Dr. Tantuwaya is a respected and highly skilled neurosurgeon, with a 22-year unblemished career,” Simmons wrote. “The records will show that Dr. Tantuwaya did not receive any kickbacks.” It will be evident that he was a victim of fraud and has launched a legal complaint against Southern California Injured Workers.”
Brill and Lee’s attorneys could not immediately be reached for comment.
Simmons stated that his client, Tantuwaya, and the other three males have all pled not guilty and been granted bail.
If convicted, Fish faces a potential term of 18 years and four months in prison, Brill a maximum of 12 years and four months in prison, Tantuwaya 13 years and four months in state prison, and Lee 12 years and four months in prison.
Fish had previously been convicted of workers’ compensation fraud twice, according to the Orange County District Attorney’s Office. This includes a 2010 conviction for remuneration or enticement for referring clients to preferred medical providers, which resulted in excessive bills.
In December 2017, the California Department of Industrial Relations prohibited Fish from participating in the state’s workers’ compensation system.
+ There are no comments
Add yours