Two Toms River residents and an Edison resident are in a heap of trouble following their Thursday arrests for their alleged roles in a scheme aimed at defrauding the New Jersey Traumatic Brain Injury Fund, a publicly health care benefit program, of more than $4,500,000.00, announced Acting U.S. Attorney Rachael A. Honig who detailed the multi-agency investigation.

Harry Pizutelli, 62, of Edison, and C.R. Kraus, 55, and Maritza Flores, 43, of Toms River were met by special agents of the FBI and IRS Thursday and are now charged by criminal complaint with conspiracy to commit health care fraud.

Honig said that Pizutelli was the manager of the TBI Fund, which provides NJ residents who have suffered a traumatic brain injury with services and support, and he was responsible for the its day-to-day operation by supervising, managing and overseeing the process where 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 the distribution of fraudulent vendor payments to Kraus, Flores, and others by generating and processing false invoices and internal payment vouchers," Honig said in a statement. "Pizutelli generated these invoices and vouchers to give the appearance that Kraus, Flores, and other conspirators had provided approved services to eligible patients when, in fact, they had not provided any services. Pizutelli then approved and transmitted the internal payment vouchers so that his conspirators received vendor payments even though they had performed no services to eligible patients. Pizutelli orchestrated these fraudulent payments to maintain and further romantic and/or sexual relationships with Flores and other conspirators."

Pizutelli was the criminal mastermind of this scheme which included "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."

Honig said that 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."

As for their charges, the health care fraud conspiracy charge carries a maximum penalty of 20 years in prison and of $250,000 or twice the gross receipts to the defendants or gross loss sustained by any victims, whichever is greater.

The government in this case is represented by J. Brendan Day, Attorney-in-Charge of the Trenton Branch Office of the U.S. Attorney’s Office.

Defense counsel:
Pizutelli – Benjamin West Esq., Assistant Federal Public Defender, Trenton.
Kraus – Bruce L. Throckmorton Esq., Trenton.
Flores – Aidan P. O’Connor Esq., Hackensack, New Jersey.

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