A man convicted of fraud in two separate cases 15 years apart and who was kicked out of California's workers' compensation system seven years ago is facing new fraud charges for a scheme that allegedly started in 2020.
The Orange County District Attorney's Office on Friday said David W. Fish, 55, and three co-defendants each face 13 felony charges, including illegal referrals for compensation, conspiracy, filing false or fraudulent claims and insurance fraud. Prosecutors allege that the three-year scheme generated nearly $100 million in fraudulent fees.
Fish allegedly formed a management company called Southern California Injured Workers with Robert Lee, 61, and attorney Martin Brill, 78. Although Fish worked for the company as a consultant, prosecutors said in a statement that he exercised complete control over the operation.
The three defendants also allegedly partnered with Dr. Vrijesh Tantuwaya, a neurosurgeon in San Diego, to create the Injured Workers Medical Group. Tantuwaya was named the owner and CEO of the professional medical company.
Southern California Injured Workers contracted with Injured Workers Medical Group to handle billing and collections, according to the felony complaint warrant.
"Using the medical group, SCIW controlled patient referrals to a limited network of providers which contracted with SCIW to pay for the patient referrals," the District Attorney's Office said in a statement. "In three years, these defendants billed nearly $100 million to numerous workers' compensation carriers and were illegally paid referral fees from providers of services such as diagnostic testing and compound pharmacies."
The complaint alleges other providers that contracted with the Southern California Injured Workers firm include All-Time Medical Interpreting, Broadway Radiology, Dunnum Occupational Care Medical Group, Excel Imaging Center, F and M Radiology, FirmaLab, US Labs Inc. and WorkMed California.
All four defendants pleaded not guilty and are currently out on bond.
The Division of Workers' Compensation in December 2017 suspended Fish under a new law that went into effect at the start of the year requiring the agency to kick out anyone previously convicted of defrauding a health care program.
The suspension notice cites a February 2010 conviction in Los Angeles County.
Fish pleaded no contest and was convicted alongside Greg Bacino, the co-owner of Premier Medical Management Systems Inc., of paying kickbacks for referrals. Among other things, Fish and Bacino agreed to walk away from liens with a total claimed value of more than $70 million.
Fish was also convicted of capping and steering work comp cases from a hospital in San Diego in 1995.
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