DA Thomas Schultz: What was Mr. Porrata's position with Matrix?

Witness Cheryl Nordheim: He was a claims supervisor and then within six months he was promoted to claims manager.

DA Thomas Schultz: And did he supervise certain workers' compensation claims?

Witness Cheryl Nordheim: Yes.

DA Thomas Schultz: What were those?

Witness Cheryl Nordheim: Largely Fleetwood Enterprises.

DA Thomas Schultz: Do you know what Cara Cruz-Thompson's position was?

Witness Cheryl Nordheim: When Hector was promoted to Manager, she was brought in as a supervisor. 

DA Thomas Schultz: Were there other supervisors?

Witness Cheryl Nordheim: No.

Cheryl went on to testify that the Matrix Ontario, California, office grew significantly during Hector's last year at Matrix and that they brought in another large account: CRM Trust Groups. The time frame for Hector Porrata and Cara Cruz-Thompson's employments was late 2003 through very early 2005.  

Here comes the transition phase between the "Double Payment Period" to the "Piece Out Of The Middle Period".  

According to Cheryl Nordheim's further testimony, there was a bill from Loma Linda Medical Center for a claimant from Fleetwood Enterprises I will call Harry Bottoms.  In came the bill for Harry Bottoms' treatment to Matrix by fax on June 21st 2004.  It was addressed to Cara Cruz-Thompson.  It read, "Attention: Cara.  Dear Cara, Here's the medical claim.  Please process."

But, apparently Cara didn't pay the bill because just a little over two months later a fax came into Matrix addressed to Jennifer Havens, who was the office manager and also acted as a claims assistant. The correspondence implied that the sender had spoken to Jennifer Havens by phone. The fax read, "You said you would have this faxed to CCN for review..." 

Well, after this event in time a demand letter came in from WCSC & Associates "A Medical Collection Service".  And here we see a new company name for Rene Montes' company: he no longer calls it WC Surgery Centers.  This starts a shift.  And it was noted in Cheryl Nordheim's testimony that Montes filed no new W-9 form. 

The address now given for WCSC & Associates is 593 Prospect Avenue in Riverside, California, which is Rene Montes' home address.  Gone is the La Habra, California, address on 1901 Lambert Road that was used for WC Surgery Centers. 

The letter now is signed by a Cecilia Nunez, as a collection representative, and the demand is for $39,543.45 on behalf of Loma Linda University Medical Center.  Hector Porrata makes a note in the claims file of the following: "Negotiated hospital bill, but I need a claims rep to adjust the reserves, since this is a $40,000 hospital bill."

DA Thomas Schultz: What would be the purpose of putting in the dollar amount in the notes?

Witness Cheryl Nordheim: To advise the client. That was part of the protocol for Fleetwood: to advise of a large bill, a large check. 

On October 18th 2004, there is a note in the file that the client, Fleetwood, is providing authorization for a reserve increase.  Then there are further notes from Cara Cruz-Thompson which read: "We have a hospital bill from Loma Linda which our manager has negotiated for $39,343.35." The manager was, of course, Hector Porrata. 

Then, on the payment display there's a payment to WC Surgery Centers (the system most likely still used that name because it was in the system and no new W-9 form was filed to change the name to WCSC & Associates) for $39,543.45 on October 18th 2004. The dates of service for Harry Bottoms are referenced April 16th to 17th 2004.

But, then almost three months later on January 14th 2005, another payment directly to Loma Linda Medical Center referencing Harry Bottoms for the same dates of service of April 16th to 17th 2004, is made for a slightly different amount of $39,357.15. This appears to be a duplicate, double payment.

But, a shift starts to take place here to the "piece out of the middle" period because for the first time a payment is found from the bank records of Rene Montes showing a payment to Loma Linda Medical Center for $1,400.00.  The check for $1,400 is issued on November 24th 2004 referencing the same dates of service: April 16th and 17th 2004.  So, it seems Rene Montes made a small payment here on November 24th 2004 directly to Loma Linda, but Hector Porrata wasn't in sync yet: he went ahead and made what appears to be a double payment to Loma Linda on January 14th for less than two hundred dollars less than the October 18th 2004 payment to WCSC & Associates.  Something was starting to change...

This next case involving Robert F. Kennedy Medical Center in Hawthorne, California, which took place around the exact same time period as the Harry Bottoms/Loma Linda Medical case seemed to have the "piece out of the middle" well executed and the "double payment" left behind.  We'll call this claimant Pedro Pedo.

Pedro Pedo had a procedure at Robert F. Kennedy Medical Center on July 13th 2004.  The total amount of the bill was $15,850.36.  So, on January 11, 2005, a demand letter came into Matrix from WCSC & Associates regarding Pedro Pedo and stamped received by Hector Porrata on January 13, 2005.  Hector made a diary note on January 13, 2005 which read: "Received bill from Robert Kennedy Medical Center. Negotiated." 

DA Thomas Schultz: No indication that the bill was sent to bill review?

Witnes Cheryl Nordheim:  No.

DA Thomas Schultz: Was there any indication of how that bill was arrived at?

Witness Cheryl Nordheim:  No there was not. 

So, Hector paid the bill to WCSC & Associates for $15, 850.36 on or around January 13, 2005. Then, there was found in the WCSC & Associates bank records from Norton Community Credit Union, a cashed check dated August 8, 2005 referencing Pedro Pedo written to Robert F. Kennedy Medical Center for $7,925.18. This was the actual payment to the real provider: eight months after WCSC & Associates was paid for their (Robert F. Kennedy's) services.  And for services for which they had no authorized representation. 

Last in the day of testimony on January 13th 2010 by Cheryl Nordheim, there was a case with Stanford University Medical Center and a physician named Eric Nelson.  In the notes of this claim Hector Porrata wrote: "Claim is orthopedic in nature.  Bill entered is for abdominal pain.  We will likely refer to his own personal insurance."  But, then after more than a year, a payment to WC Surgery Centers is found in the Matrix Records on this claim for $4,500.00.  No documentation.  No bill.  No bill review.  No explanation. 

Quirky. Double payment. Piece out of the middle payment. A payment for no reason.

To be continued...

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