O.C. man charged with workers’ comp fraud involving $100 million of billings

In a major California workers’ comp insurance case, authorities have charged an Orange County man who was twice convicted of fraud, along with a San Diego neurosurgeon and two others, in connection with allegedly billing nearly $100 million in fraudulent fees.

Following a three-year investigation, the Orange County district attorney’s office said 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 in order to receive illegal referral payments, and then unlawfully bill workers’ compensation insurance companies for these services.”

Workers’ comp fraud is estimated to be a $30-billion annual problem in the U.S., and California employers have long complained about the high cost of insurance premiums to cover employees from work-related injuries. One common scheme at so-called medical mills involves steering 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 Orange County Dist. Atty. Todd Spitzer.

Benjamin N. Gluck, Fish’s attorney in Los Angeles, said the charges are unfounded.

“The Orange County District Attorney’s Office has a history of filing similar cases only to have them collapse under scrutiny,” Gluck said. “We think this case will be just one more in that line.”

Spitzer’s office Friday also named two co-conspirators — Martin Brill, 78 of Los Angeles and Robert Lee, 61 of Rancho Mirage — alleging that they formed a firm, Southern California Injured Workers, that offered medical management services, including marketing, billing and collections. The company, in fact, was controlled entirely by Fish, authorities said.

The three co-defendants, along with San Diego neurosurgeon Dr. Vrijesh Tantuwaya, also created a medical group called Injured Workers Medical Group, which was the main client for Southern California Injured Workers. Tantuwaya was designated as the owner and CEO of this medical professional corporation, Spitzer’s office said.

The four men have been charged with 13 separate felony counts, including violations related to referral of clients for pay, conspiracy to commit a crime and insurance fraud.

Scott A. Simmons, an Irvine-based attorney for Tantuwaya, 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 said. “The records will show that Dr. Tantuwaya did not receive a single penny in kickbacks. It will become clear that he was a victim of fraud himself and, in fact, has filed a civil lawsuit against Southern California Injured Workers.”

Attorneys for Brill and Lee could not immediately be reached for comment.

Simmons said that his client, Tantuwaya, and the other three men have all pleaded not guilty and been released on bail.

If convicted, Fish faces a maximum sentence of 18 years and four months in prison; Brill, a maximum of 12 years and four months in prison; Tantuwaya, 13 years, four months in state prison; and Lee, 12 years and four months in prison.

According to the O.C. district attorney’s office, Fish was convicted twice before for workers’ comp fraud. That included a conviction in 2010 for compensation or inducement for referral of clients who went to preferred medical providers to run up high bills.

In December 2017, Fish was barred from participating in the state’s workers’ comp system by California’s Department of Industrial Relations.