Three Individuals Indicted In Connection With Plot To Defraud New Jersey Health Care Program Of Over $4.5 Million | USAO-NJ

Trenton, N.J. – Three New Jersey residents were arrested today on suspicion of participating in a long-term scheme to defraud more than $4.5 million from the New Jersey Traumatic Brain Injury Fund (TBI Fund), a publicly funded medical benefit program. rice field. Attorney Rachel A. Honig made the announcement.

Harry Pizteri, 62, of Edison, N.J., and CR Klaus, 55, and Maritza Flores, 43, of Toms River, N.J., were arrested this morning by special agents from the FBI and IRS and charged with conspiracy, according to Health. Committing care fraud. They are scheduled to appear before US Magistrate Tonianne J. Bongiovanni later today by videoconference.

According to documents and court statements filed in this case:

The TBI Foundation is a publicly funded program operated by the New Jersey Department of Services for Persons with Disabilities, a component of the New Jersey Department of Social Services. The purpose of the TBI Fund is to provide services and support to New Jersey residents who have suffered a traumatic brain injury and improve their quality of life when funds from insurance, personal resources, or other programs cannot meet their needs. is to maximize Services funded by the TBI Foundation include physical therapy, occupational therapy, and speech therapy. cognitive therapy; neuropsychological services; pharmaceuticals; installing wheelchair ramps and other home modifications. General home care and maintenance.

After a prospective patient applies for services, a TBI Foundation representative reviews the application and, if approved, authorizes the patient to secure designated services from the third-party vendor. When a patient receives services approved by her TBI Fund, the vendor or service provider submits an invoice to her TBI Fund for payment. Upon receipt of the bill, a TBI Foundation representative will review the bill to ensure the patient is authorized to receive services. Once the invoice is approved, an internal payment slip is generated, approved by TBI Foundation personnel, and submitted to the New Jersey Department of Treasury for payment. This will issue a check directly to the vendor.

Pittelli was the administrator of the TBI Foundation and was responsible for its day-to-day operations. He oversaw, managed and supervised the process by which third-party vendors were paid for services provided to eligible patients of his TBI Foundation. From 2009 until June 2019, he accused Pizutelli, Kraus, Flores, and others by diverting over $4.5 million in fraudulent vendor payments for services that were allegedly never provided. , conspired to defraud the TBI Fund. Pizutelli orchestrated the distribution of fraudulent vendor payments to Kraus, Flores, and others by generating and processing false invoices and internal payment slips. Pizztelli used these bills and slips to make it appear that Klaus, Flores, and other co-conspirators provided authorized services to eligible patients when in fact they did not. is created. Pittelli then approved and sent an internal payment voucher so the co-conspirators could receive the vendor’s payment even though they were not serving eligible patients. Pittelli arranged these fraudulent payments to maintain and further his romantic and sexual relationships with Flores and other co-conspirators.

Pittelli orchestrated over $4.5 million in fraudulent payments to members of the conspiracy from the TBI Foundation. This included his illegal distribution of over $4 million to Klaus and Flores, which they used for personal gain and affluence. To cover up their wrongdoing, Klaus and Flores made material misrepresentations on their federal income tax returns and grossly under-reported the income they earned from the fraudulent scheme.

Health care fraud conspiracy carries a maximum penalty of 20 years in prison and $250,000 or twice the defendant’s gross income or the victim’s gross loss, whichever is greater.

Deputy U.S. Attorney Honig has served under the direction of Special Agents for the FBI, the Newark Division, the Red Bank Residents Agency, under the direction of Special Agents for George M. Crouch Jr., and the IRS – I trusted the special agent for criminal investigation. Charged by Michael Montanes, the investigation led to prosecution. She also thanked the New Jersey Attorney General’s Office, the Legal Department, and the New Jersey Department of Social Services for their support.

The government is represented by J. Brendan Day, Counsel for the Trenton Branch of the U.S. Attorney’s Office.

The accusations and allegations contained in the complaint are mere accusations and the defendant is presumed innocent unless proven guilty.

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