adjustercom.com
adjustercom.net
The Stockwell Firm adjustercom publishes your thoughts and ideas...
Home
News

 Features


Other Claims News
People
Forums
The Comp Examiner Directory
The Liability Adjuster Directory
Service Provider Directory
Post a Job
View Jobs
Resumes
View Resumes
Contact Us

Adjusters Friend

jobs.adjustercom.com

 

Place Your Banner Here With A Click

 

adjustercom.net - FraudFromInsideAndOutsideTheCourtroom

 


Welcome Guest! | Login | Register with adjustercom
 
 
News

News Archive

Email a Friend Email A Friend

More News

March 25, 2024
California Division of Workers' Compensation Posts Adjustments to Official Medical Fee Schedule (Physician Services / Non-Physician Practitioner Services)

March 19, 2024
Nearly half of all litigated workers' compensation claims in the Los Angeles basin are cumulative trauma claims.

March 7, 2024
California's Division of Workers' Compensation Posts Adjustment to Official Medical Fee Schedule (Ambulance Services)

March 6, 2024
Accident Claims The Life of AdminSure Claims Adjuster Alexis Wicker



The Names Change, But The Game Remains The Same
By Lonce LaMon - May 14, 2009

I remember well back when I was a young, right-out-of-college, claims professional working at Aetna Casualty & Surety Company in the Workers' Compensation Claims Department on Wilshire Boulevard in the Mid-Wilshire District of Los Angeles in 1977. There was a senior claims adjuster who sat near me named Pat Atlow, who was a highly educated woman from the South, complete with the accent and a bottomless well of Southern charm.  She also possessed a hilarious wit and a lot of what we called "Black Attitude" back in those days. And I'll never forget how she used to boast to the Claims Manager that he got two points for her on the EEOC quota system. "One because I am Black, and the other because I'm a woman!" she used to jab at him teasingly.  Everybody in the department enjoyed the good natured humor of Pat Atlow.

Thus, when I heard last week about the scam that went on at A.I.G. and Matrix Absence Management involving Workers' Compensation Claims Adjusters Hector Porrata, George Martinez, and Cara Cruz-Thompson in connection with Rene Montes, the owner of W.C. Surgery Centers in La Habra, California, and W.C.S.C. & Associates in Riverside, my mind went back to the "Dr. Luke Reed scam" that Pat Atlow told me all about in late 1977.

"Girrrrrrrl," Pat drawled at me as we sat in a booth at Diamond Jim's restaurant that was on the first floor of the American Cement Building that housed the Aetna Casualty claims department,"They sent my Black ass out to investigate this Dr. Luke Reed that two adjusters were making payments to on files for evaluations and treatment. So, I drive to the physical location address, and as I pull up I see it's just a dirt lot. And that's when I said, 'Girrrrrrl, this smells...'"

Pat went on to tell me that it was later uncovered that two adjusters just made up this doctor named "Luke Reed" who didn't really exist.  They were mailing the payments made out to Luke Reed to a P.O. Box, and some bank teller who was in cahoots with these adjusters was cashing the checks.  So, the three partners-in-crime were spliting the money for services never rendered.

Well, just one week ago today, the foursome of Rene Montes, Hector Porrata, George Martinez, and Cara Cruz-Thompson, were arraigned on a total of 201 felony charges, accused of defrauding American International Group and Matrix Absence Management out of more than 1.4 million dollars by illegally and fraudulently settling liens on claims.

The way the scheme worked was that Rene Montes, owner of the two surgery centers, got Hector Porrata and Cara Cruz-Thompson, starting in 2003 when they both worked at Matrix Absence Management, to settle liens on claims from hospitals and doctors that he had no authority to collect on.  Porrata and Cruz-Thompson are now accused of fraudulently settling Montes' claims and paying him $310,000 from Matrix Absence Management.

Then, Hector Porrata and Cara Cruz-Thompson later left Matrix and moved over to A.I.G. in Costa Mesa, California, and somehow pulled George Martinez, another adjuster there, into their game.  From A.I.G. they continued to do business with Rene Montes and paid Montes more than $1,170,000 to settle liens.  So, from the two companies, Matrix and A.I.G., they allegedly paid out more than 1.4 million dollars fraudulently to Rene Montes.

Now, according to the District Attorney's office, the alleged fraud was discovered when A.I.G. received a payment demand letter from a hospital in February 2007 for an oustanding medical lien, which had already been paid to Montes.  A.I.G. conducted an internal audit, and discovered that Porrata, Martinez, and Cruz-Thompson were the only claims adjusters to have settled liens with Montes.  A.I.G. then reported its findings to the D.A.'s office.

The four are now being held in lieu of one million dollars bail a piece, and must prove the money is from a legal and legitimate source before posting bail.  If convicted, they could face as many as seventy years in state prison.

The way the fictitious Luke Reed was uncovered back in 1977 was because Aetna came up with a new policy that they had to have all doctors' "95 numbers" as they were called in those days.  Back in the late 70s, Federal Employers' Identification Numbers all started with a 95.  Now, FEIN numbers can start with other digits other than 95. But, then it was a "95 number" and when the person in charge of getting all the doctors' "95 numbers" tried to get Luke Reed's number, nobody came up with it.  So, that caused the first scent that Pat Atlow later really smelled at the dirt lot.

The claims adjusters' names change and years go by, but the game remains the same.  It's called embezzlement, and as Pat Atlow would say, "Girrrrrrl, this smells." 

And how. 

 
 

 Hot Jobs


Adjuster / Examiner
Claims Examiner
Santa Ana Unified School District
Santa Ana, CA
View All Jobs

The J Morey Company

Build Your Brand

jobs.adjustercom.com

The J Morey Company


    Copyright 2024 | Privacy Policy | Feedback |  

Web site engine's code is Copyright © 2003 by PHP-Nuke. All Rights Reserved. PHP-Nuke is Free Software released under the GNU/GPL license.