Convicted Fraudster Accused in $100M Workers’ Comp Fraud Scheme
A convicted fraudster with a history of workers’ compensation crimes is at the center of a new case involving nearly $100 million in fraudulent claims.
Details of the Alleged Scheme
After a three-year investigation, the Orange County District Attorney’s Office announced on Friday that David Fish, 55, of Laguna Niguel, is accused of orchestrating a complex scheme to manage clinics and providers. Fish allegedly directed providers to refer patients to specific individuals in exchange for illegal referral fees, then fraudulently billed workers’ compensation insurance companies for the services.
Fish, along with San Diego neurosurgeon Dr. Vrijesh Tantuwaya, Martin Brill, 78, of Los Angeles, and Robert Lee, 61, of Rancho Mirage, allegedly formed Southern California Injured Workers (SCIW), a medical management company. Though listed as a consultant, prosecutors say Fish exerted complete control over SCIW’s operations.
Formation of Injured Workers Medical Group
The group also created Injured Workers Medical Group, with Dr. Tantuwaya designated as its CEO. The medical group became SCIW’s primary client, funneling patients into a network of providers to submit fraudulent claims. Prosecutors estimate the group billed nearly $100 million to workers’ compensation carriers during this period.
Charges and Potential Sentences
The defendants face 13 felony charges, including conspiracy to commit a crime, client referral for compensation, and insurance fraud. If convicted, Fish could serve up to 18 years and four months in prison. Brill and Lee face maximum sentences of 12 years and four months each, while Tantuwaya could receive up to 13 years.
The Broader Impact of Insurance Fraud
Orange County District Attorney Todd Spitzer condemned the scheme, emphasizing its effect on American families. “Criminals like these drive up insurance premiums, putting the American dream further out of reach for hardworking people,” Spitzer said.
Insurance fraud costs California approximately $17.2 billion annually, translating to an average financial burden of $440 per resident through higher premiums, taxes, and prices, according to the California Department of Insurance.
Defense Statements
Fish’s attorney, Benjamin N. Gluck, argued that the charges lack merit, stating, “The Orange County District Attorney’s Office has a history of filing similar cases only to have them collapse under scrutiny.” Dr. Tantuwaya’s attorney also maintained his client’s innocence, expressing confidence that the evidence would clear his name.
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