A $100 million workers’ compensation insurance fraud scam is believed to have involved four people from Southern California.
In addition to being found guilty twice of workers’ compensation insurance fraud, Laguna Niguel resident David Fish, 55, is also suspected of billing approximately $100 million in fraudulent fees as part of a “extensive workers’ compensation fraud scheme,” along with three other suspects, according to the Orange County District Attorney’s Office.
A management business named Southern California Injured Workers (SCIW) was founded by Fish, Martin Brill, 78, and Robert Lee, 61.
In addition to marketing, invoicing, and collections, the company provided medical management services. Fish was a consultant for the business, but the DA’s office claims that he had complete control over the operations.
They collaborated with neurosurgeon Dr. Vrijesh Tantuwaya of San Diego to form the Injured Workers Medical Group (IWMG), which served as SCIW’s principal client. Tantuwaya was identified as the group’s owner and CEO.
“Using the medical group, SCIW controlled patient referrals to a limited network of providers which contracted with SCIW to pay for the patient referrals,” according to the court documents. “In three years, these defendants billed nearly $100 million dollars to numerous workers’ compensation insurance carriers and were illegally paid referral fees from providers of services such as diagnostic testing and compound pharmacies.”
There are 13 distinct felony counts against the four individuals, including violations of the following:
- Penal Code 182(a)(1) – Conspiracy to commit a crime
- Penal Code 549 – False and fraudulent claim
- Penal Code 550 (b)(3) – Insurance fraud
- Labor Code 3215 – Referral of clients for compensation
A lifelong ban from California’s workers’ compensation system was imposed on Fish due to his past convictions and his suspected role in the fraud operation.
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“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,” Orange County District Attorney Todd Spitzer stated.
If found guilty of every charge:
- Fish may spend a maximum of 18 years and 4 months behind bars.
- Brill could spend as much as 12 years and 4 months behind bars.
- Tantuwaya could spend a maximum of 13 years and 4 months behind bars.
- Lee may spend a maximum of 12 years and 4 months behind bars.
ktla.com: 4 Southern California suspects accused of $100 million workers’ comp insurance fraud scheme
