Laguna Niguel Man Charged In $100M Workers' Comp Fraud: Authorities

LAGUNA NIGUEL, CA — Four men — including one from Laguna Niguel — face charges after a three-year investigation uncovered that they were billing nearly $100 million in fraudulent fees as part of an extensive workers’ compensation scheme, according to authorities.

David Fish, 55, of Laguna Niguel; Martin Brill, 78, of Los Angeles; Robert Lee, 61, of Rancho Mirage; and Dr. Vrijesh Tantuwaya, a San Diego neurosurgeon, are charged with 13 felony counts, including conspiracy and insurance fraud, authorities said.

“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,” Orange County District Attorney Todd Spitzer said in a news release announcing the charges.

Insurance fraud costs California residents an average of $440 a year through higher premiums, taxes and prices, according to the news release.

In the scheme, Fish, Brill and Lee formed a company called Southern California Injured Workers that offered medical management services, authorities said. They also created a medical corporation, with Tantuwaya as owner and CEO, called Injured Workers Medical Group, which was the management company’s main client, according to the news release.

Using the medical group, the management company controlled patient referrals to a limited network of providers that contracted the business, authorities said. In three years, they billed nearly $100 million to insurance carriers and were illegally paid referral fees from providers of services such as diagnostic testing and compound pharmacies, according to the news release.

If convicted, Fish, who was banned for life from the state workers’ compensation system after twice being convicted of insurance fraud, faces up to 18 years and four months in prison, authorities said. Tantuwaya faces 13 years and four months, and Brill and Lee both face 12 years and four months, according to the news release.