Newsday: Valley Stream surgeon Joseph Weinstein barred from treating patients with workers' compensation claims

By: Robert Brodsky

An orthopedic spinal surgeon with an office in Valley Stream has been barred from treating patients with workers’ compensation claims, with state officials alleging he performed invasive and unnecessary procedures without medical justification, amounting to "professional misconduct," records show.

On April 2, the State Workers’ Compensation Board rejected an application by Dr. Joseph Weinstein that would allow him to continue seeking reimbursement for the treatment of injured workers, according to records made public recently after the surgeon challenged the board’s decision in state court.

Weinstein is among a number of surgeons, including several with practices on the Island, who've been named in federal racketeering lawsuits alleging they conspired with a vast network of medical providers, lawyers and other individuals to collect millions in insurance payouts for bogus accident claims.

The board detailed four patients with workers’ compensation claims treated by Weinstein that they claimed lacked credible documentation or medical justification, exhibited billing irregularities or appeared to show a predetermined outcome on the need for highly risky surgeries.

For example, Weinstein fused the spine of a 28-year-old patient involved in an alleged workplace accident, the board said, without considering less invasive and more conservative treatments.

"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 contends the surgery was needed because the patient suffered a severe spinal injury after falling 50-60 feet from a scaffold.

Messages left with Weinstein — who also has offices in Rego Park, Manhattan and New Jersey associated with Comprehensive Orthopedic & Spine Care, and who has been a licensed physician since 2009 — and with his attorney, were not returned.

Weinstein appealed the board’s decision, arguing it 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, however, rejected Weinstein’s appeal and directed him to immediately cease treating workers’ compensation claimants.

On June 16, Weinstein again petitioned the board, unsuccessfully, to reconsider its determination, arguing it relied heavily on "unproven and vigorously contested allegations" outlined in three federal racketeering cases that the surgeon has been named in.

The RICO lawsuits allege Weinstein, along with other physicians, lawyers and financiers, fraudulently conspired to treat individuals with fake or exaggerated workplace injuries, often on construction sites, to secure large payouts from insurance companies.

In its denial letter, the board noted that its medical directors’ office approved only 27% of the prior authorization requests submitted by Weinstein last year designed to cover medical costs associated with certain treatments.

Industrywide, the approval rate is about 54%, meaning that Weinstein’s preferred course of treatment was determined "clinically deficient" twice as often as the average medical provider within the workers’ compensation system, records state.

In a statement to Newsday, the board said it "takes allegations of fraud in the system seriously and investigates them with diligence. New Yorkers deserve nothing less."

Aaron Meyer, an Oceanside-based attorney who represents several insurance carriers that brought the racketeering lawsuits, said many of Weinstein’s clients are non-English speaking individuals performing difficult manual labor and who are being told they need major surgeries that will affect their ability to work for the rest of their lives.

"None of these people ever get back to work," 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."

Last month, Weinstein’s new attorneys filed a petition in state court in Schenectady County in upstate New York, seeking to annul the Workers’ Compensation Board’s denial.

The petition contends the board’s "arbitrary and capricious determination was fueled by a baseless complaint from a self-interested insurance company" and that state officials failed to consult with Weinstein’s patients, review their medical records or interview any expert witness.

"Because Dr. Weinstein was named, among many other defendants, as a defendant in a lawsuit ... the Board looked for any way to deny him renewal," Paul Schafhauser, the surgeon’s Manhattan-based attorney, wrote in his July 31 petition.

The board conceded that the four workers’ compensation cases cited in its determination letter were brought to them by a stakeholder in one of the RICO lawsuits, identified in court documents as James Manning, director of the Special Investigations Unit at New York City Transit.

Manning declined to comment through an MTA spokesman.

This is not the first time the Workers’ Compensation Board has taken action against a Long Island doctor accused of performing unnecessary surgeries on individuals accused of being involved in staged accidents.

In April, the board rejected the renewal application of Dr. Vadim Lerman, the associate director of spine surgery at Total Orthopedics & Sports Medicine, who holds the same title at Nassau University Medical Center, the cash-strapped East Meadow public hospital whose board was recently taken over by the state.

The Workers' Compensation Board accused Lerman of "billing irregularities," inadequate medical record-keeping and performing "highly invasive" surgeries without medical justification. Lerman has denied the allegations.