Laguna Niguel, CA — Four individuals have been charged in connection with a massive $100 million workers’ compensation insurance fraud scheme, according to the Orange County District Attorney’s Office.
David Fish, 55, of Laguna Niguel, who has a history of two previous convictions for workers’ compensation insurance fraud, was identified as a key figure in the alleged scheme. Alongside Fish, Martin Brill, 78, Robert Lee, 61, and neurosurgeon Dr. Vrijesh Tantuwaya from San Diego have also been implicated.
The group operated through a management company named Southern California Injured Workers (SCIW), which provided medical management services including marketing, billing, and collections. While Fish served as a consultant, he reportedly held complete control over the company’s operations.
In collaboration with Tantuwaya, the defendants established a medical group called Injured Workers Medical Group (IWMG), which served as the primary client for SCIW. Tantuwaya was listed as the owner and CEO of IWMG. According to court documents, SCIW manipulated patient referrals to a select network of providers who were contracted to pay for these referrals.
Over the span of three years, the defendants allegedly billed nearly $100 million to various workers’ compensation insurance carriers. They were also accused of receiving illegal referral fees from service providers, including those offering diagnostic testing and compound pharmacies.
All four suspects are facing 13 felony counts, including:
- Labor Code 3215 – Referral of clients for compensation
- Penal Code 182(a)(1) – Conspiracy to commit a crime
- Penal Code 549 – False and fraudulent claims
- Penal Code 550 (b)(3) – Insurance fraud
Following his previous convictions, Fish has been permanently banned from participating in California’s workers’ compensation system.
Orange County District Attorney Todd Spitzer criticized the suspects’ actions, stating, “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.”
If convicted of all charges, the potential sentences for the defendants include:
- Fish: Up to 18 years and four months in prison
- Brill: Up to 12 years and four months in prison
- Tantuwaya: Up to 13 years and four months in prison
- Lee: Up to 12 years and four months in prison
Spitzer reaffirmed the commitment of the Orange County District Attorney’s Office to prosecute those who exploit the workers’ compensation system for personal gain. “We remain fiercely committed to prosecuting bad actors who exploit the workers’ compensation system to line their own pockets rather than helping injured workers,” he said.
