A San Diego neurosurgeon is among four people Orange County prosecutors allege were part of an extensive workers’ compensation scheme that billed nearly $100 million in fraudulent fees.
The other defendants include a 55-year-old Laguna Niguel man who has already been twice convicted of insurance fraud — including a 1995 conviction in San Diego — and has been banned for life from California’s workers’ compensation system, authorities said Friday.
For three years, authorities investigated that man, David Fish, before accusing him of “continuing 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,” the Orange County District Attorney’s Office said in a statement.
Fish was labeled as a consultant, but prosecutors accused him of controlling the operation. Fish faces charges of conspiracy, referring clients for compensation, and insurance fraud, according to court records. He pleaded not guilty in Orange County Superior Court on Oct. 1.
“We believe the charges are unfounded and we intend to prove it,” said Benjamin Gluck, Fish’s attorney.
Prosecutors said Fish and two others formed Southern California Injured Workers, which offered medical management services, including marketing, billing and collections, officials said.
Dr. Vrijesh Tantuwaya, a San Diego neurosurgeon, is accused of working with the men and creating the Injured Workers Medical Group, which prosecutors said was the main client of Fish’s management company.
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According to prosecutors, Southern California Injured Workers controlled referrals to contracted providers, billed multiple workers’ compensation insurance carriers and received illegal payments from service providers for diagnostic testing and compound pharmacies, prosecutors said.
Tantuwaya pleaded not guilty in Orange County Superior Court on Sept. 9 to conspiracy, false or fraudulent claim, and insurance fraud.
“Dr. Tantuwaya, a respected and highly skilled neurosurgeon, with a 22-year unblemished career, categorically denies the allegations raised by the Orange County district attorney,” said his lawyer, Scott Simmons, in a statement.
“Dr. Tantuwaya maintains his complete innocence and is confident that the evidence will demonstrate his lack of involvement in any illegal activities. … The records will show that Dr. Tantuwaya did not receive a single penny in kickbacks. … As soon as these allegations came to light, Dr. Tantuwaya fully cooperated with DA investigators, confident that the facts will vindicate him,” Simmons said.
Also charged were Martin Brill, 78, of Los Angeles and Robert Lee, 61, of Rancho Mirage. Each faces conspiracy and insurance fraud charges, and each pleaded not guilty in August. The Union-Tribune has reached out to attorneys for Brill and Lee for comment.
Insurance fraud raises premiums and taxes for others, officials said. According to the Orange County District Attorney’s Office, the California Department of Insurance has determined that such fraud costs Californians an average of $440 annually.
Percy writes for Southern California News Group. Union-Tribune staff writer Teri Figueroa contributed to this report.