Man charged in $100 million staff’ comp fraud scheme

A person beforehand convicted of staff’ compensation fraud has been charged for the third time in reference to an alleged $100 million scheme involving a neurosurgeon and two others, in line with the Orange County District Legal professional’s Workplace.

In line with AM Finest, the 4 defendants face 13 felony expenses, together with conspiracy to commit a criminal offense, referral of purchasers for compensation, and submitting false and fraudulent claims, as outlined by the district legal professional.

David Fish, one of many defendants, is accused of controlling clinics and healthcare suppliers who would see sufferers after which refer them to sure suppliers in trade for unlawful referral funds. These providers had been billed to staff’ compensation carriers, in line with the District Legal professional’s Workplace.

Fish has beforehand been convicted twice for staff’ compensation fraud and is completely banned from collaborating in California’s staff’ compensation system, the workplace mentioned.

Fish allegedly labored with Martin Brill and Robert Lee to create Southern California Injured Employees (SCIW), an organization that supplied medical administration providers, together with advertising and marketing, billing, and collections.

Whereas Fish was listed as a guide for the corporate, the district legal professional claims he had full management over its operations.

The group additionally partnered with San Diego neurosurgeon Vrijesh Tantuwaya to kind a medical group named Injured Employees Medical Group, which grew to become SCIW’s major consumer. Tantuwaya was listed because the proprietor and CEO of the group, in line with the district legal professional.

The group operated the scheme for 3 years, directing affected person referrals to a restricted group of clinics, submitting claims nearing $100 million, and receiving unlawful referral charges, the District Legal professional’s Workplace mentioned.

Orange County District Legal professional Todd Spitzer (pictured above) addressed the broader influence of insurance coverage fraud, noting that schemes like this drive up prices for American households.

Spitzer mentioned that whereas individuals are going through growing bills, “criminals like these solely enhance the price of insurance coverage premiums and put the American dream additional out of attain for a lot of hardworking individuals.”

If convicted, Fish might resist 18 years and 4 months in jail. Brill and Lee might every face a most sentence of 12 years and 4 months, whereas Tantuwaya might obtain a sentence of as much as 13 years.

Insurance coverage fraud in California prices roughly $17.2 billion yearly, in line with the California Division of Insurance coverage, with the monetary influence leading to a median value of $440 per resident resulting from larger premiums, taxes, and costs.

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