In a serious California staff’ comp insurance coverage case, authorities have charged an Orange County man who was twice convicted of fraud, together with a San Diego neurosurgeon and two others, in reference to allegedly billing almost $100 million in fraudulent charges.
Following a three-year investigation, the Orange County district lawyer’s workplace mentioned on Friday that David Fish, 55, of Laguna Niguel allegedly masterminded an intensive 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.”
Employees’ comp fraud is estimated to be a $30-billion annual downside within the U.S., and California employers have lengthy complained in regards to the excessive price of insurance coverage premiums to cowl workers from work-related accidents. One widespread scheme at so-called medical mills includes steering staff to hunt medical therapy from particular medical 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,” mentioned Orange County Dist. Atty. Todd Spitzer.
Benjamin N. Gluck, Fish’s lawyer in Los Angeles, mentioned the fees are unfounded.
“The Orange County District Attorney’s Office has a history of filing similar cases only to have them collapse under scrutiny,” Gluck mentioned. “We think this case will be just one more in that line.”
Spitzer’s workplace Friday additionally named two co-conspirators — Martin Brill, 78 of Los Angeles and Robert Lee, 61 of Rancho Mirage — alleging that they fashioned a agency, Southern California Injured Employees, that provided medical administration providers, together with advertising and marketing, billing and collections. The corporate, actually, was managed completely by Fish, authorities mentioned.
The three co-defendants, together with San Diego neurosurgeon Dr. Vrijesh Tantuwaya, additionally created a medical group known as Injured Employees Medical Group, which was the primary shopper for Southern California Injured Employees. Tantuwaya was designated because the proprietor and CEO of this medical skilled company, Spitzer’s workplace mentioned.
The 4 males have been charged with 13 separate felony counts, together with violations associated to referral of purchasers for pay, conspiracy to commit a criminal offense and insurance coverage fraud.
Scott A. Simmons, an Irvine-based lawyer for Tantuwaya, mentioned in an announcement that his shopper “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 mentioned. “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 couldn’t instantly be reached for remark.
Simmons mentioned that his shopper, Tantuwaya, and the opposite three males have all pleaded not responsible and been launched on bail.
If convicted, Fish faces a most sentence of 18 years and 4 months in jail; Brill, a most of 12 years and 4 months in jail; Tantuwaya, 13 years, 4 months in state jail; and Lee, 12 years and 4 months in jail.
In accordance with the O.C. district lawyer’s workplace, Fish was convicted twice earlier than for staff’ comp fraud. That included a conviction in 2010 for compensation or inducement for referral of purchasers who went to most popular medical suppliers to run up excessive payments.
In December 2017, Fish was barred from collaborating within the state’s staff’ comp system by California’s Division of Industrial Relations.
