A Long Island spinal surgeon, who also helps run Nassau University Medical Center’s orthopedics department, is asking an upstate court to reinstate his ability to treat patients with workers’ compensation claims, records show.
In April, the State Workers’ Compensation Board told Dr. Vadim Lerman, associate director of spine surgery at Total Orthopedics & Sports Medicine, who holds the same title at NUMC, it was rejecting his renewal application allowing him to seek reimbursement for the treatment of injured workers.
The board cited five cases of Lerman — who has been named in four civil federal racketeering lawsuits, alleging he conspired with others to collect millions in insurance payouts for bogus accident claims — performing “highly invasive” surgeries without medical justification; questionable “billing irregularities” and inadequate medical recordkeeping.
‘Baseless complaint’
In mid-August, Lerman filed a petition in state court in Schenectady County seeking to annul the state’s denial, which his attorneys described as “arbitrary, capricious and unlawful.”
WHAT NEWSDAY FOUNDA Long Island spinal surgeon is asking an upstate court to reverse a decision by the State Workers’ Compensation Board and reinstate his ability to seek reimbursement for the treatment of injured workers.In April, the board rejected an application by Dr. Vadim Lerman, associate director of spine surgery at Total Orthopedics & Sports Medicine, to treat patients with workers’ compensation claims.Lerman, whose company operates the Orthopedics Department at NUMC, has been named in four civil federal racketeering lawsuits, alleging he conspired with others to collect millions in insurance payouts for bogus accident claims.
Medical providers are required to reapply for authorization with the board every two or three years, in line with their State Education Department license renewal.
“The WCB’s determination is unsustainable: it is based on a baseless complaint from a self-interested insurance company, unsupported by credible evidence, constitutes an abuse of discretion, and is marred by multiple legal and procedural errors,” wrote Mickey Keane, one of Lerman’s Great Neck-based attorneys. … “The WCB’s decision was not the product of a fair or objective regulatory process. Instead, it was driven by speculation, mischaracterizations of clinical care, and disregard for basic due process protections.”
In a strategy similar to arguments made in the same court last summer by Dr. Joseph Weinstein, another Long Island doctor barred from treating injured workers, Lerman alleged the board’s actions were “part of a broader campaign” initiated by the insurance companies that filed the RICO cases in New York’s Eastern District.
In addition, Keane said an “expert” spinal surgeon reviewed Lerman’s work and concluded that his treatment methods were proper.
But James Tacci, the board’s medical director, wrote in an Oct. 24 letter to the court that Lerman’s “expert” has no experience in New York’s workers’ compensation system and is not authorized to treat injured workers in the state.
‘Dangerous and improper treatment’
The five patient cases cited by the board, Keane wrote, were brought forward 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.
In an Oct. 24 court filing, Michael Papa, the board’s general counsel, said Lerman’s claims were “baseless” and that the application rejection came after a review of the doctor’s cases determined he “engaged in dangerous and improper treatment of injured workers.”
“The Board’s reasonable investigation of the RICO complaint allegations is what the governmental entity charged with the fair administration of the [workers’ compensation law] should do when it receives allegations of this nature,” Papa wrote. “And where the Board’s investigation reveals unnecessary, invasive, dangerous and potentially life altering treatment … the Board has an obligation to protect injured workers by denying the practitioners … authorization to provide care to injured workers.”
In the cases detailed by the board, Lerman was criticized for opting for “predetermined” surgical procedures after only an initial consult, without full patient evaluations or exploring more conservative treatment options — including on patients as young as 24 — and without sufficient documentation to support the treatment.
The board concluded Lerman’s behavior “amounts to professional misconduct.”
Directed from Total Orthophedics to NUMC
Lerman is a board-certified orthopedic spinal surgeon who continues to hold staff appointments at Beth Israel Medical Center, Mount Sinai South Nassau, NUMC and at Northwell Health hospitals.
Total Orthopedics, which has four Nassau locations, and Lerman personally were named as defendants in several federal lawsuits, including one alleging they conspired with several Freeport residents, a Manhattan law firm and a vast network of other medical providers to collect millions in insurance payouts for fraudulent accident claims.
No one has been criminally charged in connection with the cases, but the Brooklyn District Attorney’s Office, which declined to comment, has opened a criminal investigation connected to the RICO complaints, records show.
Court records reviewed by Newsday contend that surgeons at Total Orthopedics see patients — typically litigants in lawsuits stemming from alleged accidents in Brooklyn — and then direct them to spinal surgery at NUMC in East Meadow, which they or their colleagues later perform.
Those surgeries are often performed on individuals without insurance, so the costs of the expensive procedures are absorbed by the hospital, which is already $1.4 billion in debt, records show.
The top leadership at Total Orthopedics simultaneously operate the Orthopedics Department at NUMC, whose oversight board has been taken over by the state.
Robert Brodsky is a breaking news reporter who has worked at Newsday since 2011. He is a Queens College and American University alum.