Four Southern California suspects, including David Fish, 55, of Laguna Niguel, have been charged in a $100 million workers’ compensation insurance fraud scheme, according to the Orange County District Attorney’s Office.
David Fish, previously convicted twice for workers’ compensation fraud, is accused alongside Martin Brill, 78, Robert Lee, 61, and San Diego neurosurgeon Dr. Vrijesh Tantuwaya of orchestrating the extensive fraud.
The group formed Southern California Injured Workers (SCIW), a management company offering medical management services such as marketing, billing, and collections. Fish acted as a consultant but had full control of the operation, according to the DA’s office.
They then established a medical group called Injured Workers Medical Group (IWMG), with Dr. Tantuwaya listed as the owner and CEO. SCIW directed patient referrals to a select network of providers who paid referral fees to the company. In just three years, nearly $100 million in fraudulent fees were billed to various workers’ compensation insurance carriers.
Court documents reveal that the defendants were illegally paid referral fees for services such as diagnostic testing and compound pharmacies, violating numerous felony statutes including conspiracy and insurance fraud.
If convicted, Fish could face up to 18 years and four months in prison, while his co-defendants Brill, Tantuwaya, and Lee face sentences ranging from 12 to 13 years.
Orange County District Attorney Todd Spitzer condemned the scheme, stating, “Criminals like these only increase the cost of insurance premiums and put the American dream out of reach for so many hardworking people.”
The four suspects face charges including conspiracy, false claims, and insurance fraud, with the DA’s office committed to prosecuting those who exploit the workers’ compensation system.
