4 Southern California suspects accused of $100 million workers’ comp insurance fraud scheme

Four Southern California suspects have been charged for their alleged involvement in a $100 million workers’ compensation insurance fraud scheme.

According to the Orange County District Attorney’s Office, David Fish, 55, from Laguna Niguel, was twice convicted of workers’ compensation insurance fraud and, along with three other suspects, was accused of their involvement in billing nearly $100 million in fraudulent fees as part of an “extensive workers’ compensation fraud scheme.”

Fish, along with Martin Brill, 78, and Robert Lee, 61, formed a management company called Southern California Injured Workers (SCIW).

The company offered medical management services including marketing, billing, and collections. Fish worked for the company as a consultant, but had full control over the operation, according to the DA’s office.

They paired up with San Diego neurosurgeon Dr. Vrijesh Tantuwaya to create a medical group called Injured Workers Medical Group (IWMG), which was the main client for SCIW. Tantuwaya was listed as the owner and CEO of the group.

“Using the medical group, SCIW controlled patient referrals to a limited network of providers which contracted with SCIW to pay for the patient referrals,” court documents said. “In three years, these defendants billed nearly $100 million dollars to numerous workers’ compensation insurance carriers and were illegally paid referral fees from providers of services such as diagnostic testing and compound pharmacies.”

All four suspects have been charged with 13 separate felony counts which include violations of:

• Labor Code 3215 – Referral of clients for compensation
• Penal Code 182(a)(1) – Conspiracy to commit a crime
• Penal Code 549 – False and fraudulent claim
• Penal Code 550 (b)(3) – Insurance fraud

Fish has been banned for life from California’s workers’ compensation system following prior convictions and his alleged involvement in the fraud scheme.

“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,” said Orange County District Attorney Todd Spitzer.

If convicted on all charges:

• Fish faces up to 18 years and four months in prison
• Brill faces up to 12 years and four months in prison
• Tantuwaya faces up to 13 years and four months in prison
• Lee faces up to 12 years and four months in prison

“The Orange County District Attorney’s Office remains fiercely committed to prosecuting bad actors who exploit the workers’ compensation system to line their own pockets rather than helping injured workers,” Spitzer said.

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