SAN DIEGO, CA — An extensive workers’ compensation fraud investigation lasting three years has led to charges against four men, one of whom is a neurosurgeon from San Diego, for allegedly billing nearly $100 million in fraudulent fees, according to law enforcement officials.
David Fish, 55, from Laguna Niguel; Martin Brill, 78, from Los Angeles; Robert Lee, 61, from Rancho Mirage; and Dr. Vrijesh Tantuwaya, the neurosurgeon in question, are facing 13 felony charges, which include conspiracy and insurance fraud, as reported by authorities.
“While families nationwide are grappling with rising costs for essential needs like gas and rent, these criminals exacerbate the financial burden of insurance premiums, pushing the American dream further out of reach for countless hardworking individuals,” stated Orange County District Attorney Todd Spitzer in a news release regarding the charges.
According to the news release, insurance fraud costs residents of California an average of $440 annually, manifesting as increased premiums, taxes, and prices.
As part of this fraudulent scheme, Fish, Brill, and Lee established a company named Southern California Injured Workers that provided medical management services. They also founded a medical corporation led by Tantuwaya as owner and CEO, called Injured Workers Medical Group, which became the primary client of the management company, as per the news release.
The management company utilized the medical group to oversee patient referrals to a restricted network of service providers that contracted their services, according to authorities. Over three years, they allegedly billed approximately $100 million to insurance companies and unlawfully received referral fees from service providers like diagnostic testing labs and compound pharmacies, as detailed in the news release.
If found guilty, Fish, previously banned for life from the state workers’ compensation system after two convictions for insurance fraud, could face a sentence of up to 18 years and four months in prison. Tantuwaya could receive a sentence of 13 years and four months, while both Brill and Lee are facing potential sentences of 12 years and four months, according to the news release.
