Subject Numbers Regarding Health Provider Authorizations

Authorization No. 180670-2W

November 20, 2013

Pursuant to Workers' Compensation Law Section 13-d(4), the Chair of the New York State Workers' Compensation Board has exercised his authority to temporarily suspend Dr. Jack Bertolino’s authorization to treat injured workers within the New York State workers’ compensation system effective October 16, 2013. Dr. Bertolino's last known business address is 5839 Main Street, Suite 102, Williamsville, NY 14221.

The Chair’s designee’s investigation revealed that the Department of Health, Bureau of Professional Medical Conduct (BPMC) issued BPMC Order # 12-197, effective October 3, 2012, wherein, a Consent Order was issued setting forth an Order of Conditions. The Order of Conditions is for a period of two years and restricts Dr. Bertolino’s medical license in that he can only practice medicine while being monitored by a licensed physician who is board certified in an appropriate specialty.

Therefore, the Chair believes that Dr. Bertolino may be guilty of misconduct, and that such misconduct would detrimentally affect the quality of care provided to injured workers.

Dr. Bertolino is prohibited from rendering treatment and care to injured workers while his authorization is temporarily suspended. Reports submitted by Dr. Bertolino for services rendered prior to October 16, 2013, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Bertolino for services rendered prior to October 16, 2013 should not be denied due to the suspension of his authorization.

This suspension remains in effect until further notice. Any questions regarding the authorized lists should be referred to the Medical Director's Office at 1 (800) 781-2362.