Surgeon Barred from Treating Workers’ Compensation Patients

Long Island, NY (WorkersCompensation.com) – The New York State Workers’ Compensation Board has barred an orthopedic spinal surgeon from treating patients with workers’ compensation claims.

State officials allege Dr. Joseph Weinstein, a surgeon working in Valley Stream, a neighborhood on Long Island, N.Y., had behavior that amounted to “professional misconduct” for performing procedures that were unnecessary.

He was one of more than a dozen doctors and seven practices with more than 40 locations across Long Island, who were named in a federal lawsuit alleging they were involved in a vast conspiracy along with lawyers and other individuals to collect millions in insurance payouts for fake accident claims.

In that case, announced in May, federal investigators alleged lawyers and insurance companies recruited individuals to stage slip and fall accidents, which were then directed to carefully chosen medical providers who would inflate or falsify their treatment needs to increase the insurance payouts.

The board detailed four patients who filed workers’ compensation claims treated by Weinstein that they claimed lacked the necessary documentation or medical justification for the procedures. Additionally, they found billing irregularities and the appearance that Weinstein had presented a need for highly risky surgeries.

According to an investigation by Newsday, in one example Weinstein performed a spinal fusion on a 28-year-old patient involved in an alleged workplace incident without considering other treatments that were less invasive.

"Your treatment of this claimant consisted of an invasive and potentially life altering (for the worse) spinal fusion, which appears to have been insufficiently justified, and indeed medically unnecessary," James A. Tacci, the board’s medical director, and Michael Papa, its general counsel, wrote in their 19-page letter to Weinstein.

Weinstein said the surgery was needed because the patient suffered a severe spinal injury after a 5+ story fall.

After the initial finding, Weinstein appealed the board’s ruling and said the ruling was “riddled with inaccuracies and false conclusions and ignore or overlook pertinent patient records and treatment history ... Indeed, if the Board, [Medical Director’s Office] and [General Counsel] were truly interested in discovering the truth, they would have — and, in fact, should have — at the very least spoken with Dr. Weinstein at some point during the investigation and before rendering a determination."

The board rejected Weinstein’s appeal and ruled he would need to cease treating workers’ compensation claimants immediately.

On June 16, Weinstein petitioned the board again to reconsider its ruling. Weinstein this time argued the board relied on “unproven and vigorously contested allegations” from the federal racketeering cases the surgeon had been named in.

The board denied that petition as well, saying its medical directors’ office had only approved 27 percent of Weinstein’s prior authorization requests last year to cover medical costs associated with certain treatments. The approval rate is about 54 percent industrywide, the board said, which meant Weinstein’s treatments were determined to be “clinically deficient” twice as often as the average workers’ compensation medical provider.

One attorney who represented several insurance carriers in the racketeering lawsuits said many of Weinstein’s clients were non-English speaking and that the surgeries affected their ability to work.

"None of these people ever get back to work," attorney Aaron Meyer said. "Instead, they're being told, ‘You need major surgery. You need to have your neck fused or your back fused.’ You're a 20-something-year-old, and suddenly your neck is fused. You're stuck with that for life. And if you're still a manual laborer. You're in trouble down the line. And these people are profiting off them."

Weinstein’s attorneys have filed a petition in state court to annul the Workers’ Compensation Board’s latest denial. The petition argues the board’s determination was arbitrary and capricious.

The board also took action this year against another doctor in Long Island accused of performing unnecessary surgeries on people accused of staging accidents.

In April, Dr. Vadim Lerman’s renewal application was denied. The board alleges that Lerman, the associate director of spine surgery at Total Orthopedics & Sports Medicine, performed “highly invasive” surgeries without medical justification, as well as inadequate medical record-keeping and “billing irregularities.”

Lerman denies the allegations.

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