A federal racketeering case is being brought against multiple physicians and medical providers, including some on Long Island, for allegedly performing unwarranted surgeries on construction workers in fraudulent accidents.
Two insurance providers, Roosevelt Road Re and Tradesman Program Managers, filed the lawsuit on June 16 in the New York Eastern District Court in Brooklyn.
It names 47 defendants in the racketeering case. While a vast majority of the defendants hail from New York City and its boroughs, five named medical providers have ties to Long Island. Two corporations and two individuals included as defendants are unnamed.
Manhasset-based William Schwitzer & Associates is named in the suit as allegedly leading the scheme through its use of individuals to recruit construction workers in staging accidents and claiming injuries.
These workers were promised compensation via Workers’ Compensation benefits and additional funds “in order to cover any theoretical gap in pay in the form of litigation funding loans arranged by Schwitzer defendants,” the suit states.
New York Scaffold laws permit workers to claim a workplace injury based solely on gravity and they do not need to prove negligence for their accident. This places the liability on property owners, employers and contractors.
One of the Long Island affiliated providers is Total Orthopedics & Sports Medicine, which also provides orthopedic services for Nassau University Medical Center, the county’s public hospital.
Total Orthopedics & Sports Medicine has eight locations in Brooklyn, Queens, The Bronx, Massapequa, Syosset, East Meadow, and Deer Park, four of which are in Nassau County.
The two physicians at the center of this case against Total Orthopedics are Dr. Vadim Lerman, the associate director of spine surgery based in Massapequa, and Dr. Abhishek Kumar, an orthopedic surgeon.
Evidence submitted in the case includes a letter from the state Workers’ Compensation Board, which denies Lerman reauthorization for treating injured workers.
This letter was addressed to Lerman and Total Orthopedics & Sports Medicine, which operates in Massapequa, Syosset, The Bronx and Brooklyn.
The board lists multiple concerns, including performing invasive surgeries with risk of injury and complications, a lack of justification for these procedures, a lapse in credible record keeping and billing irregularities.
These concerns are then outlined in detail through explicit instances, dating back to 2022 and continuing through this year.
“Indeed, taken in aggregate, these claims appear to indicate a consistent series of noncompliant behaviors that deviate from the expected standard of care and administrative standards of professional behavior,” the Workers’ Compensation Board wrote.
This is the second lawsuit of this nature brought against Total Orthopedics & Sports Medicine.
The suit does not include criminal charges.
The other Long Island medical firms named in the suit are New York Sports and Joints Orthopedic Specialists, with offices in New Hyde Park and Ronkonkoma; Advanced Orthopedics and Joint Preservation in Valley Stream; New York Spine Institute, based in Westbury and with an office in Commack; and Katzman Orthopedics, based in Floral Park.
The doctors named in association with these providers are orthopedic surgeon Dr. Kevin Wright with New York Sports and Joints Orthopedic Specialists, Advanced Orthopedics and Joint Preservation owner Dr. Stanislav Avshalumov, New York Spine Institute owner Dr. Alexandre de Moura, and Katzman Orthopedics founder Dr. Barry Katzman.
de Moura, a second-generation orthopedic surgeon who has performed spinal surgeries for 30 years, denied the allegations. He said his medical practice is not affiliated with anyone and does not “collude” with anyone.
“I vehemently defend my reputation,” de Moura said.
He said that he did not know who the two patients were that the lawsuit alleges he wrongfully treated, but that they were referred to him through workers’ compensation.
“When [workers’] compensation authorizes surgery, as a doctor, you would assume that the patient who was involved in an accident, indeed that accident transpired,” de Moura said.
He said his patients are treated “conservatively” and that they were only referred to him for surgery because other more conservative treatments had failed to help them. He said the patients he sees are typically eight months to a year from their injury, and have exhausted other options before going to surgery.
de Moura said the suit also alleges that one of his patients was “temporarily totally disabled” six weeks after spinal surgery, but he said that is expected for an individual recovering from a major surgery.
Advanced Orthopedics and Joint Preservation declined to comment. Efforts to solicit comments from the other providers with ties to Long Island were unavailing.
Roosevelt Road Re and Tradesman Program Managers, the two insurance groups who brought forward the suit, have also been accused of “shadow insurance” schemes. These are ploys to transfer insurance policy claims to less-regulated entities. A February letter from state assembly members to Attorney General Letitia James called for an investigation.
Efforts to solicit comment from the Willis Law Group, which is representing the plaintiffs, were unavailing.
