Bronx Hospital Employee Gets Prison Term For Stealing $1.7 Million By Submitting Forged Serostim Prescriptions To Out-of-state Pharmacies

Attorney General Spitzer today announced that former Montefiore Medical Center employee Enrique Rojas has been sentenced to one and two-third years to five years in state prison for stealing more than $1.7 million from taxpayers during a nine-month period by faxing hundreds of forged prescriptions for the AIDS medication Serostim to out-of-state pharmacies.

The pharmacies, in turn, filled the prescriptions, shipped the medications to various New York City addresses being used by Rojas, including his own residence, and billed the New York State Medicaid program for having dispensed the expensive medication. The Medicaid program reimburses providers $6,300 for a month's supply of Serostim.

Once Rojas received the drugs, he sold them on the black market. A month's supply of Serostim has an estimated street value of $3,000 to $3,200.

Serostim is approved only for the treatment of AIDS wasting – a life-threatening condition characterized by the involuntary loss of more than 10% of a patient's body weight – and cachexia (a general wasting of the body during a chronic disease). However, the drug is illicitly used by bodybuilders and other athletes seeking to increase their muscle mass.

"The successful prosecution of this case, coupled with a substantial prison sentence, sends a clear message that health care fraud will not be tolerated," said Spitzer. "Particularly disturbing is how the black market demand for this high-cost drug has caused substantial over-utilization of the medication. American taxpayers have paid tens of millions of dollars every year for the abuse of this powerful drug."

Rojas, who was sentenced today in Albany County Court before Judge Stephen W. Herrick, was also ordered to pay $1,759,842 in restitution. He pleaded guilty on July 17, 2002, to Grand Larceny in the First Degree, the top count of the 19-count indictment pending against him since May 2002. Rojas was immediately remanded.

The scheme was uncovered when New York State officials from the Department of Health noted that Medicaid billings for the Pittsburgh-based TDI Pharmacy, Inc., one of the pharmacies used by Rojas, had dramatically spiked from less than $1 million in 1999 to more than $4.5 million in 2000.

Rojas admitted that, in his position as an HIV Education Coordinator at various Montefiore clinics, he obtained the names and identification numbers of dozens of unsuspecting Medicaid patients, as well as the license and Drug Enforcement Administration identification numbers of several hospital physicians. Rojas then used this information to generate fake prescriptions for Serostim, which he faxed to various mail-order pharmacies. As a result, between January and September 2000, these pharmacies improperly received more than $1.7 million in Medicaid funds.

In carrying out his scheme, Rojas paid Medicaid recipients and friends to use their home or business addresses as the shipping locations for the prescribed drugs. Rojas paid these individuals $50 to $100 for each package they received.

Spitzer thanked the state Health Department for referring the matter to his office, and for its assistance and cooperation during the investigation.

Enrique Rojas, 43, of 6 McGeory Avenue in Bronxville, New York, was employed by Montefiore Medical Center from May 1998 to September 2000.

The case was prosecuted by Special Assistant Attorney General Jay Speers and former Special Assistant Attorney General Michael P. Sofarelli, Deputy Director of the Medicaid Fraud Control Unit's Special Projects Unit. Special Investigator Timothy F. Cleary, Senior Special Investigator James Spellman, and former Associate Special Auditor Investigator Michael Scognamiglio assisted in the investigation.