Calif. Work Comp Doc, Arrested Before but Not Convicted, Charged with Insurance Fraud Again

A Northern California doctor is charged — once again — with insurance fraud for allegedly overcharging workers’ compensation insurers for services at his pain management practice.

The San Francisco District Attorney’s Office charged Dr. Gary Martinovsky and his office assistant with 40 insurance fraud charges, including fraudulent billing, double billing and billing for services not rendered.

The DA’s office said in a press release than Martinovsky and his practice, Integrated Pain Care, have filed 3,005 liens with the Department of Industrial Relations claiming $29 million in unpaid bills. The office said since 2022, Martinovsky has filed more liens with the Department of Industrial Relations than any organization except the state Employment Development Department, which frequently files liens to collect reimbursement for unemployment insurance benefits paid to workers’ compensation claimants.

“Medical provider fraud is a major cost driver for Workers Compensation insurance in our State,” District Attorney Brooke Jenkins said in a press release. “These scams serve to enrich unscrupulous providers while driving up costs for the rest of us. My office will not tolerate scams like this and will seek to hold those responsible accountable.”

Martinovsky was charged once before with insurance fraud, but was not convicted. The Alameda County District Attorney’s Office arrested him in May 2014, but later dropped the fraud charges because they were filed in the wrong county.

Martinovsky filed a defamation lawsuit against the Alameda County District Attorney Nancy E. O’Malley and the investigating officers, which was settled out of court. Contra Costa County prosecuted Martinovsky on one felony charge, but that charge was reduced to a misdemeanor and dismissed entirely after the doctor completed a diversion program.

This time it is San Francisco County, on the other side of the bay, that is pursuing charges. Prosecutors say Martinovsky and his mother-in-law and office assistant, Raisa Rikoshinsky, filed liens asking for payment of bills that has already been paid in full or in part.

Such liens are allowed in California’s workers’ compensation system and often used by medical providers to pursue payment for treating injured workers whose claims were not accepted by the employer or insurer.

According to the charges, Martinovsky and Rikoshinsky filed fraudulent documents along with the liens or failed to disclose that the liens had already been paid. Prosecutors charge that Martinovsky and his practice billed three insurers for services not rendered, by claiming $625 numerous times for services not provided.

Martinovsky’s liens have been stayed while criminal charges are pending, state records show. Martinovsky and Rikoshinsky are scheduled to be arraigned on Jan. 12.

For a fraud suspect, Martinovsky has an impressive resume. He obtained an undergraduate degree from the University of California, Berkeley and then graduated medical school at Stanford University. After that, he completed a post-graduate fellowship in pain medicine at the University of California, Davis. California Medical Board records show that his license is in good standing and he has no record of disciplinary action.

The doctor’s civil complaint filed in federal court in January 2016 accused the district attorney and Insurance Department fraud investigators of being “compromised by political pressure and donations from insurance carriers.”

The criminal charges filed contained deliberately false and recklessly misleading statements and omissions of material facts,” the complaint says. Martinovsky said Department of Insurance officers “raided” his practice and threatened to shut it down after sending in undercover agents who posed as injured workers.

In an amended complaint, Martinovsky specifically accused the Knox Ricksen law firm, which represents insurance carriers, of pushing the DA’s office to investigate him.

District Court Judge Maxine M. Chesney dismissed many, but not all, of Martinovsky’s claims in March 2017. The case was dismissed completely in February 2018 after the parties attended a six-hour settlement conference, court records show.

Martinovsky has also tangled in court with Liberty Mutual. He once was part of the insurance carrier’s medical provider network, but he sued the carrier in 2016 after it removed him. His complaint alleges Liberty Mutual refused to authorize functional restoration services for his patients and pressured them to instead seek care at a pain management “many miles away” in San Mateo County.

That lawsuit was also was dismissed after the parties reached a confidential settlement.