NEW JERSEY – Two people, a former manager of the New Jersey Traumatic Brain Injury Fund (TBI Fund) and one of his conspirators, admitted to defrauding a publicly funded health care benefit program of more than $4.5 million, officials said.
Maritza Flores, 45, of Toms River, pleaded guilty to conspiracy to commit healthcare fraud and tax evasion. Harry Pizutelli, 64, of Edison, pleaded guilty to one count of conspiracy to commit healthcare fraud.
Previously, Pizutelli, Flores, and co-defendant C.R. Kraus were charged with conspiracy to commit healthcare fraud in connection with a scheme to defraud the TBI Fund of millions of dollars of public funds for their own personal benefit.
The TBI 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. It provides 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.
In order to receive services, a patient must be approved and afterward will receive an internal payment voucher.
According to officials, Pizutelli was the manager of the TBI Fund and was responsible for supervising the process by which third-party vendors were paid for services rendered to patients.
Officials said that 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. Fake invoices were created and processed, making it appear that these services were provided to patients. Pizutelli then approved and transmitted the internal payment vouchers, officials said.
“Pizutelli orchestrated these fraudulent payments to maintain and further romantic and/or sexual relationships with Flores and other conspirators,” officials said. “Pizutelli orchestrated the fraudulent payment of more than $4.5 million from the TBI Fund to members of the conspiracy, including more than $940,000 in fraudulent distributions to Flores and more than $3.245 million in fraudulent distributions to Kraus, which they used for their own personal benefit and enrichment.”
In addition, Flores and Kraus evaded the payment of substantial amount of income taxes by making misstatements on their federal income tax returns and underreporting their income.
Pizutelli and Flores each face a maximum penalty of 10 years in prison for the healthcare fraud conspiracy charge. Flores also faces a maximum penalty of 10 years in prison for the tax evasion charge. Sentencing for Pizutelli is scheduled for May 8, and for Flores, May 9.
Charges against Flores are accusations until proven guilty.