Prior convictions can have a significant impact on new allegations. In a major California workers’ compensation insurance case, authorities have charged a man who was twice convicted of fraud, along with a San Diego neurosurgeon and two others, in connection with allegedly billing nearly $100 million in fraudulent fees. Following a three-year investigation, on October 18, 2024, California’s Orange County district attorney’s office said that for three years, they investigated David Fish, before they accused him of anything. What they found was that Fish controlled medical clinics and providers who would see patients and refer them to specific providers in order to receive illegal referral payments. The D.A. then alleged that Fish unlawfully billed workers’ compensation insurance companies for these services. Furthermore, Fish has been banned for life from California’s workers’ compensation system following prior convictions in 2017. Sometimes, a zebra can’t change their stripes.
Prosecutors said Fish and his co-conspirators formed Southern California Injured Workers, which offered medical management services, including marketing, billing and collections. Under Fish’s management, Southern California Injured Workers controlled referrals to contracted providers, billed multiple workers’ compensation insurance carriers and received illegal payments from service providers for diagnostic testing and compound pharmacies.
Concurrent with Southern California Injured Workers forming, the co-defendants created a medical group called Injured Workers Medical Group. Which coincidentally was the main client for Southern California Injured Workers. Using the medical group, Southern California Injured Workers controlled patient referrals to a limited network of providers which contracted with Southern California Injured Workers to pay for the patient referrals. 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.
On October 14, 2024, the four men were charged with thirteen separate felony counts.
Excellent job by the California Department of Insurance in this case.
Today’s Fraud of The Day is based on article “San Diego neurosurgeon among four accused of $100M insurance fraud scheme” published by The San Diego Union Tribune on October 14, 2024.
Orange County prosecutors said the scheme involved taking money for patient referrals. A San Diego neurosurgeon is among four people Orange County prosecutors allege were part of an extensive workers’ compensation scheme that billed nearly $100 million in fraudulent fees.
The other defendants include a 55-year-old Laguna Niguel man who has already been twice convicted of insurance fraud — including a 1995 conviction in San Diego — and has been banned for life from California’s workers’ compensation system, authorities said Friday.
