$4.5M Stolen From NJ Brain Injury Fund; Toms River Woman Admits Role

TRENTON, NJ — A Toms River woman has pleaded guilty in a fraud scheme that stole more than $4.5 million from a state program aimed to assist people who have suffered traumatic brain injuries.

Maritza Flores, 45, pleaded guilty before U.S. District Judge Zahid N. Quraishi in Trenton on Wednesday to conspiracy to commit health care fraud and tax evasion, the U.S. Attorney Philip R. Sellinger announced.

Flores pleaded guilty along with Harry Pizutelli, 64, of Edison, in the long-running scheme. Pizutelli, the former manager of the New Jersey Traumatic Brain Injury Fund (TBI Fund), a publicly funded health care benefit program.

In January 2021, Pizutelli, Flores, and co-defendant C.R. Kraus were charged with conspiracy, accused of diverting millions of dollars for their own personal benefit. The charges against Kraus remain pending, Sellinger's office said.

The TBI Fund is run by the New Jersey Division of Disability Services, a component of the state Department of Human Services.

The fund exists 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.

Services funded by the TBI Fund include physical, occupational, and speech therapy; service coordination; assistive technology; cognitive therapy; neuropsychological services; pharmaceuticals; wheelchair ramp installation and other home modifications; and general home management and maintenance.

After a prospective patient applies for services, TBI Fund personnel review the application and, if approved, the patient is authorized to secure designated services from a third-party vendor. Once a patient receives services approved by the TBI Fund, the vendor or service provider submits an invoice to the TBI Fund for payment. When an invoice is received, TBI Fund personnel review the invoice to ensure that the patient had been approved to receive the services. If the invoice is approved, an internal payment voucher is generated, authorized by TBI Fund personnel, and then submitted to the state for payment, which issues a check directly to the vendor.

Pizutelli, as manager, was responsible for the fund's 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, Flores, and others worked together to generate and process false invoices and internal payment vouchers to give the appearance that 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.

Pizutelli orchestrated the fraudulent payments to maintain and further romantic and/or sexual relationships with Flores and others, Sellinger said.

More than $940,000 in fraudulent distributions went to Flores, the U.S. attorney's office said. Flores also evaded paying substantial amounts of income taxes by making material misstatements and omissions on their federal income tax returns and significantly underreporting the income they had derived from the fraudulent scheme.

The health care fraud conspiracy charge to which Pizutelli and Flores each pleaded guilty carries a maximum penalty of 10 years in prison and a maximum fine of $250,000 or twice the gross receipts to the defendants or gross loss sustained by any victims, whichever is greater.

The tax evasion charge to which Flores pleaded guilty carries a maximum penalty of 10 years in prison and a maximum fine of $250,000.

Sentencing for Pizutelli is scheduled for May 8 and for Flores on May 9, Sellinger's office said.