A man banned for life from California’s workers’ compensation system after being twice convicted of workers’ compensation insurance fraud, along with a San Diego-based neurosurgeon and two other co-conspirators, have been charged in a $100 million fraudulent billing scheme.

The charges follow a three-year investigation by the Orange County District Attorney’s Office into twice convicted felon David Fish who is accused of continuing to control clinics and providers who would see patients, refer them to specific providers in order to receive illegal referral payments, and then unlawfully bill workers’ compensation insurance companies for these services.

Fish, 55 of Laguna Niguel, Martin Brill, 78 of Los Angeles, and Robert Lee, 61 of Rancho Mirage, formed Southern California Injured Workers (SCIW), a management company which offered medical management services, including marketing, billing, and collections. Fish worked for the company as a “consultant,” but exercised complete control over the operation.

The co-defendants, along with San Diego neurosurgeon Dr. Vrijesh Tantuwaya, also created a medical group called Injured Workers Medical Group (IWMG), which was the main client for SCIW. Dr. Tantuwaya was named the owner and CEO of this medical professional corporation.

The four co-defendants have been charged with 13 separate felony counts, including 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) and Penal Code 550 (b)(3) (insurance fraud).

Using the medical group, SCIW controlled patient referrals to a limited network of providers that contracted with SCIW to pay for the patient referrals.

Within three years, nearly $100 million dollars was billed to numerous workers’ compensation insurance carriers and were illegally paid referral fees from providers of services such as diagnostic testing and compound pharmacies.

If convicted, Fish faces maximum sentence of 18 years and four months in prison. Brill faces maximum of 12 years and four months in prison, Tantuwaya faces 13 years, four months in state prison and Lee faces 12 years and four months in prison.