2 From Ocean Co Charged in Scheme to Defraud NJ Brain Injury Fund

Two people from Ocean County and another person from North Jersey have been arrested for allegedly participating in a long-running scheme to defraud the New Jersey Traumatic Brain Injury Fund of more than $4.5 million.

Acting U.S. Attorney Rachael A. Honig says 55-year-old C.R. Kraus and 43-year-old Maritza Flores, both of Toms River, and 62-year-old Harry Pizutelli of Edison, were arrested Wednesday are charged with conspiracy to commit health care fraud.

According to Honig's office,

The TBI (Traumatic Brain Injury) Fund is a publicly funded program run by the New Jersey Division of Disability Services, a component of the New Jersey Department of Human Services. The TBI Fund’s purpose is to provide New Jersey residents who have suffered a traumatic brain injury with services and support in order to maximize their quality of life when funding from insurance, personal resources, or other programs is unavailable to meet their needs.

Pizutelli was the manager of the TBI Fund and was responsible for the its day-to-day operation. He supervised, managed, and oversaw the process by which third-party vendors were paid for services rendered to eligible TBI Fund patients. From 2009 through June 2019, Pizutelli, Kraus, Flores, and others conspired to defraud the TBI Fund by misappropriating more than $4.5 million in fraudulent vendor payments for purported services that were never actually provided.

Pizutelli orchestrated these fraudulent payments to maintain and further romantic and/or sexual relationships with Flores and other conspirators.

Pizutelli orchestrated the fraudulent payment of more than $4.5 million from the TBI Fund to members of the conspiracy, including more than $4 million in fraudulent distributions to Kraus and Flores, which they used for their own personal benefit and enrichment. To obscure their fraudulent conduct, Kraus and Flores also made material misstatements on their federal income tax returns, by significantly underreporting the income they had derived from the fraudulent scheme.

The health care fraud conspiracy charge carries up to 20 years in prison and a $250,000 fine or twice the gross receipts to the defendants or gross loss sustained by any victims, whichever is greater.