Cheryl Nordheim is a full-figured, light skinned blonde woman who appeared calm and confident as she went through document after document on the Witness Stand.  She wore a dark powder blue shell top with a light weight matching cardigan sweater over it with pants.   Let me discuss now her testimony and a related testimony that came from a surgeon who testified later, on January 25th, 2010.  It ties in.

I’m going to call this period from late 2003 to early 2005, which is the basic time frame when Hector Porrata was working at Matrix Absence Management in Ontario, the “Double Payment Period”.   Cara Cruz-Thompson was only involved in one of the claims about which Cheryl testified during this time period, which covers the entire year of 2004.

Hector was first the supervisor and then the claims manager.  It appears that Hector and Rene Montes changed and evolved their scam over time, because when Hector got to AIG and Cara followed, they would pay large sums to WCSC & Associates (Rene Montes) for liens, usually 100 cents on the dollar, and then Rene would negotiate that sum way down to an amount which was much less and pay that through his bank account to the real lien holder.

But, during the Matrix “Double Payment Period” the scam was different.  During this period Hector was making double payments: he would pay the real lien holder a sum of money very close to the same amount that he was paying to Rene Montes.  But Rene Montes was using the dba of WC Surgery Centers at this time, and was taking the original bill from a real hospital or surgery center, deleting the real hospital/surgery centers’ names, and typing in WC Surgery Centers. 

Here are some examples from Cheryl Nordheim’s testimony of January 13th:

I will use fictitious names for the claimants, as I overheard some whispering of the defense attorneys with the Judge one day last week, mostly from Mary Kreber, George Martinez’ attorney, that she is concerned about me using the real names of the claimants and violating their privacy rights in my reporting.  Therefore, I am going to respect Mary’s concerns, and I am going to use funny, fake names I remember joking about during my childhood.

So, this first claimant I will call Aaram Pitts.  The names of the hospitals/medical centers I will use from here forward will be real and actual, as will the numbers be real and actual.

Aaram Pitts was a 51-year-old male who was treated at Riverside Community Hospital. His treatment was from July 2003 to August 2003.  The treating physician was Thomas T. Hader. 

A bill came in from WC Surgery Centers, 1901 Lambert Road, La Habra, CA 93061.  Its subtitle under its letterhead read “A Network of Surgery Centers”.   On the document was  Thomas T. Hader as the treating physician, Riverside Hospital as the facility, and the demand for payment.   Thus, it looked like WC Surgery Centers was the parent administrator of this network for which Riverside Hospital was a member.

DA Thomas Schultz:  Did this document appear strange to you?

Witness Cheryl Nordheim: Yes, because it was written out to WC Surgery Centers and it appeared to be hand typed. 

So, this demand for payment had originally come from Riverside Hospital.  But Riverside Hospital and its address had been whited out and WC Surgery Centers with its address had been hand typed with a conventional typewriter over the blank space which had been created by whiting out Riverside Hospital.

In Hector’s file notes he had written:  I have forwarded bill to this company because I believe we can obtain greater savings.  I queried claims manager (Dan Peterson) and we did not have a specific Review Service for hospital, per se. 

So, Hector is making this fake WC Surgery Centers “A Network of Surgery Centers” look like a bill review service that oversees surgery centers in a type of bill review consortium.  The Matrix regular bill review company was Community Care Network or CCN, and they did review the bill, according to Cheryl Nordheim’s testimony, but clearly Hector ignored that review and made Rene Montes’ WC Surgery Centers his new “bill review company” specifically for surgeries.    

Hector authorized and paid $56,500 to WC Surgery Centers (Rene Montes) on January 8, 2004 for the treatment/surgery of Aaram Pitts.  This was paid for by Fleetwood Motor Homes, aka Fleetwood Enterprises, which was a self-funded, self-insured client of Matrix’s. 

 DA Thomas Schultz:  Any reference as to how $56,500 was come up with?

Witness Cheryl Nordheim: No.

DA Thomas Schultz:  Appears to be out of the blue? 

Witness Cheryl Nordheim:  Yes. 

On one of the letters from WC Surgery Centers it reads, Please see attached hospital claim.

DA Thomas Schultz:  Did you see any attached hospital claim?

Witness Cheryl Nordheim:  No. 

Then in another note to the file written by Hector, it reads: Please pay attached invoice.  But there was no invoice.  Further notes read: Phone call to Chris Ayers, employer.  Advised that a large check would be issued for claimant surgery. 

On January 8, 2004, Hector wrote: I am adjusting reserve to cover medical treatment.  Doing full reserve analysis.   On January 9, 2004, according to a document presented as evidence, the payment to WC Surgery Centers was processed. 

Fast forward a little more than three months to April 12, 2004.  Employee 236, Hector Porrata writes in notes to file: Received hospital bill.  $73,043.76.  Then on April 14, 2004 a payment of $54,784.99 is issued directly to Riverside Hospital for treatment of the exact same dates: July 31st to August 5th 2003, for claimant Aaram Pitts, Fleetwood Enterprises.

DA Thomas Schultz: In your opinion, was there a duplicate payment?

Witness Cheryl Nordheim:  Yes.

The next claim for which Cheryl Nordheim gave her testimony was also from the Matrix client: Fleetwood Enterprises.  I’ll call this claimant Willie Makeit.  It was handled by employee 236, who was Hector Porrata.  In his claim file notes on December 12, 2003, he wrote: Received a call from employer (Fleetwood).  Advised claimant was having surgery.  Asked to pay TTD. 

On December 19, 2003 a line by line billing was received from Advanced Diagnostic & Surgery Center, referencing surgeon Kenneth P. Simm for patient Willie Makeit.  On January 16, 2004 the bill was reviewed by CCN (the Matrix bill review company) and adjusted to $9,263.15.  But on January 17, 2004 a bill was received from WC Surgery Centers for the exact same amount: $9,263.15 referencing the same dates of service and surgeon, Kenneth P. Simm.  It has the same exact information as the billing from Advanced Diagnostic & Surgery Center.  It again, according to Cheryl’s testimony, appears to have been hand typed. 

Then there’s a letter from WC Surgery Centers which reads “This letter will confirm our agreement to satisfy this account for $8,500.00.”

DA Thomas Schultz: Was there any evidence that WC Surgery Centers went through CCN Bill Review?

Witness Cheryl Nordheim:  No, there was not. 

Therefore, on February 2, 2004 a check was issued to WC Surgery Centers for $8,500.00.   But on May 3, 2004 a check for $9,263.15 was issued to Advanced Diagnostic & Surgery Center.  These two payments show on the Matrix computer system’s Summary Payment Spread Sheet.  Thus, this is a second example of Hector doing a double payment. 

The next case in Cheryl’s testimony involved Hamid Rehman, M.D., the surgeon with Pacific Hospital who performed a carpal tunnel release on a claimant I will nickname Ima Hog. 

Pacific Hospital’s detailed billing came to Matrix for $16,924.00 on October 14, 2003.  Then, a bill from WC Surgery Centers came also on October 14, 2003 for $16,924.00 referencing Hamid Rehman, M.D.  Cheryl was again asked by the DA to testify as to the strangeness of this near mirror image of a billing from WC Surgery Centers.

DA Thomas Schultz:  Does this bill appear to be made in the same way as the previous bills?  What is the strangeness of this document?

Witness Cheryl Nordheim:  It appears to be hand typed.

Then a letter came from WC Surgery Centers on January 28, 2004, which read: This letter will confirm to resolve our bill for $16,000.00.   Hector Porrata date stamped it on January 29, 2004.  He wrote by hand on it: Okay to pay.  On the letter it further read: Please direct your payment as follows:  WC Surgery Centers, 1901 Lambert Road, La Habra, CA 90631.  The document of the payment display showed the check was issued on February 4, 2004, five days after Hector signed Okay to pay on the letter. 

But in May of 2004, CCN reviewed the original Pacific Hospital bill from October 23, 2003. 

DA Thomas Schultz:  Why should it take so long?

Witness Cheryl Nordheim:  It shouldn’t.  I honestly don’t know.
 
The original bill was for $16, 924.00 and CCN adjusted it to $16,266.00.  So, a payment was issued in May of 2004 directly to Pacific Hospital for $16,266.00 by Hector Porrata.  It was another double payment.

On January 25, 2010, surgeon Hamid Rehman, M.D. took the stand.  He is an aging middle-aged doctor with a grey beard and a grey mustache who sounded to me like he was from the Middle East.  The DA questioned Dr. Rehman.

DA Thomas Schultz:  Have you ever heard of WC Surgery Centers?

Witness Hamid Rehman, M.D.:  No.

DA Thomas Schultz:  Have you ever heard of Rene Montes?

Witness Hamid Rehman, M.D.: No. 

DA Thomas Schultz:  Did you perform surgery regarding Ima Hog at WC Surgery Centers in La Habra?

Witness Hamid Rehman, M.D.: No.

The DA stated he had no further questions.  Then the Judge, Elaine Streger, asked the three defense attorneys if they had any further questions for this witness.  All three defense attorneys stated that they had no further questions for the witness. 

This period at Matrix happened before Hector worked as a temporary adjuster at AIG in Santa Ana.  Some more testimony came from Cheryl Nordheim, and a bit of it included Cara Cruz-Thompson.  But I’ll report some more coming up on the remainder of this Matrix “Double Payment” period, and then shift to the next period that changes at AIG where WC Surgery Centers (Rene Montes) shifts to using predominantly the dba of WCSC & Associates and stops using WC Surgery Centers. 

What he does in his next period which I’ll call the “Piece Out Of The Middle Period” is he pays the real lien claimants from his WCSC bank account while Hector, Cara, and sometimes George pay WCSC & Associates 100 cents on the dollar of the original lien demand.  Moving forward in time it appears that con-artist Rene Montes was working at perfecting his art, evolving his craft, but he and the other three defendants never ceased to be anything but sloppy. 

Readers may write to writer Lonce LaMon at lonce@adjustercom.com