Neurosurgeon among 4 charged in $100M insurance fraud scheme: 5 notes

Spine

Four people, including a neurosurgeon, were charged in connection with a scheme involving fraudulent workers' compensation, The San Diego Union-Tribune reported Oct. 14.

Five things to know:

1. Vrijesh Tantuwaya, MD, a neurosurgeon in San Diego, David Fish, and two other people were charged in the scheme that billed nearly $100 million in fradulent fees, the report said. Mr. Fish was previously convicted twice of insurance fraud.

2. Mr. Fish and two other people formed Southern California Injured Workers, which offered medical management services, including billing and collections. Dr. Tantuwaya allegedly worked with the group and created the Injured Workers Medical Group. That was Mr. Fish's management company main client.

3. According to procesutors, Southern California Injured Workers oversaw referrals to contracted providers, billed workers' compensation insurance companies and took illegal payments for diagnostic testing and compound pharmacies.

4. Dr. Tantuwaya pleaded not guilty to charges of conspiracy, false or fraudulent claim, and insurance fraud, the report said. A statement from his lawyer said he "categorically denies" the allegations, the report said. 

5. Mr. Fish also pleaded not guilty. His attorney said in the report that the charges are "unfounded." Mr. Fish's co-conspirators pleaded not guilty to conspiracy and insurance fraud charges.

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