News: 2010 Press Release
For Release: February 19, 2010
Media Calls Only: 916-492-3566
Insurance Commissioner Poizner Announces Two San Diego Men Plead No Contest in Workers' Compensation Fraud Cases
Duo Agree to Forgo $60 Million in Medical Liens and Bills Pending at WCAB
California Insurance Commissioner Steve Poizner today announced that David Wayne Fish, 47, of San Diego and Birger Greg Bacino, 50, of Rancho Santa Fe, have plead no contest to felony charges of compensation or inducement for referring clients for profit in a workers' compensation scheme and agreed to release $60 million in medical liens and bills prior to entering their plea. They will serve three years of probation.
Fish and Bacino are the principal owners of Premier Medical Management Systems Inc. The business was charged with making false and fraudulent workers' compensation claims and filing false tax returns. At its peak, Premier Medical owned and operated five clinics in the greater Los Angeles area and contracted with more than 100 medical providers. More than
$60 million in liens and bills created by Premier Medical Management Systems Inc. were pending before the Workers' Compensation Appeals Board (WCAB) and as part of the negotiated disposition, Fish and Bacino agreed to drop those claims.
"Getting kickbacks for referring medical payments is illegal and drives up the costs in the system," Commissioner Poizner said. "Because of our work and that of the Los Angeles District Attorney's office, we were able to prevent $60 million in fraudulent and unnecessary claims in being made. We will continue to work hard to eliminate these unneeded costs to keep workers' compensation insurance affordable."
A California Department of Insurance (CDI) Fraud Division investigation alleged that Fish and Bacino purchased large blocks of workers' compensation client referrals from a prominent attorney television advertising service. CDI investigators reviewed more than 100,000 financial records in tracing the flow of money.
The investigation found that when a referral was received for a prospective workers' compensation case, the client was sent to doctors and other health care providers that had a business relationship with Premier. Premier would do the billing and collection work in return for a 50 percent or more fee of what they collected. More than 16,000 patient referrals were purchased through the attorney advertising service.
After the client had been sent to the doctors and other healthcare providers, the client would then be sent to various workers' compensation attorneys that had a financial relationship with Fish and Bacino.
The Los Angeles County District Attorney's Office, the Franchise Tax Board, U.S. Postal Inspection Service and the National Insurance Crime Bureau made major contributions to the investigation.
As part of the negotiated plea, CDI received $900,000 as reimbursement for investigative costs.
In return for the lien dismissals and payment of the costs of the investigation, both suspects will be granted felony probation. Sentencing will occur June 25, 2010 according to the Los Angeles County District Attorney's Office.
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