A former manager of the New Jersey Traumatic Brain Injury Fund (TBI Fund) and a conspirator recently admitted that they spent several years defrauding the publicly funded healthcare benefit program. Residents of New Jersey, the defendants were each charged with the conspiracy to commit healthcare fraud and tax evasion. There are still charges pending against a third defendant.
The New Jersey Division of Disability Services, a New Jersey Department of Human Services component, runs the TBI Fund. It was created to help those who suffer from traumatic brain injuries – these often result from blunt trauma to the head or whiplash. Football players are particularly susceptible, but the injuries also are caused by motor vehicle crashes, violent falls and other cataclysmic events.
Often difficult to successfully treat and sometimes involving debilitating life-changing consequences, TBI victims often need physical, occupational or speech therapy. The TBI Fund provides these services and other assistance to the injured (such as home modifications, ramps and assistive technology).
The scam
Once applicants are approved, they can get services from third-party vendors. The TBI Fund reviews the bills and submits a voucher request to the New Jersey Department of the Treasury, which issues the payment. From 2009 to 2019, the manager submitted voucher requests for services not provided. The payments would then go to the co-conspirators. The manager also maintained a series of romantic or sexual relationships with the co-conspirators. The defendants used that money for their benefit or enrichment. They also did not report the money to the IRS as part of the scheme. They face up to 10 years in jail, and a maximum fine of $250,000 or twice the amount was stolen (whichever the greater amount is).
Holding scammers accountable
Those identifying healthcare fraud schemes can report them to state and federal authorities. Their help can better ensure that the fraudsters are held accountable for their actions.
