Man charged in $100 million employees’ comp fraud scheme

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

In line with AM Best, the 4 defendants face 13 felony fees, together with conspiracy to commit against the law, referral of purchasers for compensation, and submitting false and fraudulent claims, as outlined by the district lawyer.

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 change for unlawful referral funds. These companies had been billed to employees’ compensation carriers, in response to the District Lawyer’s Workplace.

Fish has beforehand been convicted twice for employees’ compensation fraud and is completely banned from taking part in California’s employees’ compensation system, the workplace stated.

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

Whereas Fish was listed as a advisor for the corporate, the district lawyer 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 turned SCIW’s major consumer. Tantuwaya was listed because the proprietor and CEO of the group, in response to the district lawyer.

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 Lawyer’s Workplace stated.

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

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

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

Insurance coverage fraud in California prices roughly $17.2 billion yearly, in response to the California Division of Insurance coverage, with the monetary influence leading to a mean value of $440 per resident on account of increased premiums, taxes, and costs.

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