California neurosurgeon among four charged in $100 million insurance fraud scheme – East Bay Times

A San Diego neurosurgeon is among four people Orange County prosecutors say were part of a massive workers’ compensation scheme that charged nearly $100 million in fraudulent fees.

Other defendants include a 55-year-old Laguna Niguel man who was twice previously convicted of insurance fraud – including a 1995 conviction in San Diego – and was banned for life from the system workers’ compensation system in California, authorities said Friday.

For three years, authorities investigated this man, David Fish, before accusing him of “continuing to control clinics and providers who saw patients, directing them to specific providers in order to receive illegal referral payments, and then illegally billed workers’ compensation insurance companies.” for these services,” the Orange County District Attorney’s Office said in a statement.

Fish was labeled a consultant, but prosecutors accused him of controlling the operation. Fish faces charges of conspiracy, turning away clients to obtain compensation and insurance fraud, according to court records. He pleaded not guilty in Orange County Superior Court on October 1.

“We believe the accusations 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 say was the primary client of Fish’s management company.

Prosecutors say injured Southern California workers controlled referrals to contracted providers, billed multiple workers’ compensation insurance companies and received illegal payments from service providers for diagnostic tests and compound pharmacies, prosecutors said.

Tantuwaya pleaded not guilty in Orange County Superior Court Sept. 9 to conspiracy, false or fraudulent claims and insurance fraud.

“Dr. Tantuwaya, a respected and highly skilled neurosurgeon with an unblemished 22-year career, categorically denies the allegations raised by the Orange County District Attorney,” his attorney, Scott Simmons, said in a statement.

“Dr. Tantuwaya maintains his complete innocence and is convinced that the evidence will demonstrate his absence of involvement in illegal activities. … Records will show that Dr. Tantuwaya did not receive a single penny in bribes. … As soon as these allegations came to light, Dr. Tantuwaya cooperated fully with the DA investigators, confident that the facts would prove him right,” Simmons said.

Also charged were Martin Brill, 78, of Los Angeles, and Robert Lee, 61, of Rancho Mirage. Each faces charges of conspiracy and insurance fraud, and each pleaded not guilty in August. The Union-Tribune has contacted attorneys for Brill and Lee for comment.

Insurance fraud raises other people’s premiums and taxes, 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 per year.

Percy writes for the Southern California News Group. Union-Tribune Staff Writer Teri Figueroa contributed to this report.

Originally published: October 15, 2024 at 4:56 a.m.