Records: Fake scripts used for PEDs

MIAMI -- The South Florida clinic suspected by Major League Baseball investigators of being a source of performance-enhancing drugs for more than 30 players, including Alex Rodriguez and Melky Cabrera, in some instances obtained the banned substances through forged prescription forms, according to documents obtained by "Outside the Lines."

Anthony Bosch, the self-described biochemist who operated a series of wellness clinics, used prescription forms that contained forged signatures, stamped with the names and license numbers of legitimate physicians who apparently were unaware of the scheme, sources and documents indicate. Those drugs were prescribed to Bosch's friends and associates and then delivered to professional athletes in order to avoid a paper trail, sources said.

Already the subject of a civil lawsuit filed by MLB and a Florida Department of Health investigation, Bosch could face possible felony criminal charges if tied to forged medical prescriptions, as well as fraud for acting as a medical doctor.

The signed prescriptions are among a folder full of documents obtained by "Outside the Lines" that also identify players Bosch is believed to have dealt with, some of whom he personally visited during spring training and in-season.

The documents show:

• Multiple prescription forms bearing the purported signature of Dr. Daniel Carpman, a Coral Gables anti-aging specialist who denies signing the forms. The claim by the one-time Bosch associate -- who says he ended their relationship over concerns about Bosch's operation -- is supported by a forensic handwriting expert retained by "Outside the Lines."

• That Biogenesis relied on compounding pharmacies as a source for producing creams and "troches," or lozenges, containing, in some cases, amounts of testosterone nearly 15 times the levels available by prescription at neighborhood or traditional pharmacies. The levels might be a clue as to why at least five MLB players associated with Bosch have so far tested positive for substances banned by baseball, though clinic insiders also suggest some may have used more than the recommended amounts.

• That Bosch, 49, incorporated into his treatments peptides such as CJC and GHRP, which are designed to trigger the body's release of human growth hormone.

• That HGH is referenced next to three players: injured New York Yankees star Rodriguez, San Diego Padres catcher Yasmani Grandal and minor league pitcher Cesar Carrillo -- the latter two having been suspended by Major League Baseball, though not related to HGH. Grandal is suspended the first 50 games of this season after testing positive for elevated testosterone levels, while Carrillo, a minor league player not protected by the players' union -- was suspended 50 games for his name having appeared in Biogenesis documents, and another 50 for lying to MLB about not knowing Bosch.

• Biogenesis records also link Rodriguez, Grandal and Carrillo with Actovegin, a drug extracted from calf's blood that is not approved for use in the United States.

Health-care experts say Bosch was able to operate by exploiting loopholes in Florida law, which provides only limited oversight to the distribution of prescription drugs. One compounding pharmacy, however, says it suspected Biogenesis might be distributing anabolic steroids and terminated its relationship with the clinic last year.

Bosch, who has denied dealing in performance-enhancing drugs, did not respond to messages seeking comment. His attorney said Friday she did not know anything about the latest documents and therefore could not comment.

None of the documents are more revealing -- as well as perhaps legally damaging -- than prescription forms purported to have been signed by Carpman. When "Outside the Lines" showed Carpman prescriptions bearing his signature last month, he studied the signatures. "This is for sure not my handwriting," said Carpman, pulling back in his chair.

Sources familiar with his clinic said it was common for Bosch to sign patient prescriptions. Sources also said Bosch injected some non-athlete patients with fake drugs, either saline solution or bacteriostatic water instead of the HGH or HCG they thought they had paid for.

Bosch was known to deal only in performance-enhancing and anti-aging substances, not narcotics or prescription pills, sources said. He also was known to favor maintaining written records and logs, fearing computer files would leave a more traceable trail. He didn't accept insurance or Medicare, which would have created another level of legal trouble. Instead, multiple sources said he dealt only in cash.

The prescriptions purported to be signed by Carpman were both dated the same day: Feb. 22, 2011. Both are signed with two identical looping, indistinguishable letters and appear to be copies of the same template. Both prescribed three identically formulated substances, which by itself is a red flag because compounding pharmacies aren't a one-size-fits-all, but rather exist to create specific pharmaceutical products for unique individual patient needs. Prescribed here in mirror form were, as written:

• testosterone cream 4mg – transdermal #30

• L-glutathiones cream transdermal #30

• testosterone troche (lozenger) 20mg sublingual gel mint flavor #30

One name listed in the prescription paperwork is Carlos Acevedo, then 32, a close associate of Bosch's in the wellness industry. Acevedo is named along with Bosch and three others in the lawsuit brought by Major League Baseball last month. They were partners in a company called Biokem, but went their separate ways after a dispute.

Acevedo, accused with others in the MLB suit of soliciting or inducing players to purchase performance-enhancing substances, most recently served as program director for hormone therapy treatment at Revive Miami, his Coral Gables clinic that shut down in December. Acevedo has denied repeated requests for comment.

The other patient identified on a Biogenesis prescription form, Eddie Gonzalez, then 38, was described by several sources as a friend of Bosch. Gonzalez has also either hung up when called or denied repeated requests for comment.

Carpman, the physician, said he is not familiar with either Acevedo or Gonzalez.

"It is like a robbery," Carpman said of his name on the prescription forms. "You feel bad."

Without prodding, in an interview, Carpman, 60, turned over a prescription form and on the back hastily scribbled four variations of his signature. Neither these samples nor Carpman's signature on a document previously filed with the Florida Secretary of State's Office appear to match the abbreviated, stylized signature on the prescriptions in the Biogenesis records, according to an analysis by a retired special agent with the U.S. Army Criminal Investigation Command.

"Based on the known samples, Carpman is probably not the writer," said forensic document examiner Farrell Shiver, who was retained by "Outside the Lines" to review the documents and writing samples. "It is probably not his [signature]. It is not consistent with the samples. The samples and the [Secretary of State] document are similar to one another, and they are not consistent with what is on these [prescriptions]."

After studying writing samples of Bosch, Shiver said he couldn't reach a conclusion on whether he penned Carpman's signature.

But the forensic specialist was able to link Bosch to another prescription obtained by "Outside the Lines" -- this one purportedly written by the late Dr. Arturo Perez. Shiver contended that writing samples for Perez were "not consistent at all with the signature that is on the [prescription] document." Again, he couldn't conclusively say who signed the prescription, but Shiver determined -- based on a review of writing samples -- that it is highly probable Bosch filled out the patient information on the form, as well as writing in the five prescribed medications, including a testosterone cream and lozenges.

"There are numerous individual handwriting characteristics in there that are consistent," Shiver said, referring to a comparison of Bosch writing samples and the prescription form.

Florida Department of Health spokespeople declined several requests to make an official available to discuss the possibility medical prescriptions may have been forged, telling "Outside the Lines" in a statement: "The Department remains committed to protecting the integrity of the practice of medicine in Florida." As for issues with forged signatures on prescriptions, a spokesperson wrote: "Pharmacists are not required to fill any prescription they think may be forged or suspicious on some way."

At least on the surface, the prescription form linked to the late Dr. Perez would appear to raise legal and ethical questions, especially, if as the forensic examiner suggests, it was filled out by Bosch. Consider:

• The address listed for the patient, identified as Danny Hernandez, is that of Bosch's parents in Coral Gables.

• The phone number listed for the patient on the form is Bosch's own cell number.

• The date isn't filled in on the prescription order form, so the time frame of when it was written is in doubt. But Dr. Perez passed away in November 2011 at the age of 81.

David Rabbani, president of Hallandale Pharmacy, a compounding facility that sits a couple blocks from the pristine horse track, Gulfstream Park -- almost 25 miles north of Miami, told "Outside the Lines" his pharmacy stopped doing business with the Biogenesis clinic early last summer after receiving a prescription for anabolic steroids, though at the time officials were unaware Bosch was behind the Coral Gables operation.

As he's queried about the relationship, Rabbani stresses often that he runs a tight, clean ship, unlike some of his Sunshine State competitors. He pulls out what the pharmacist refers to as the "Dr. Bosch file."

He says Biogenesis first opened an account in April 2012, a month after state records indicate it was incorporated. Rabbani said staff was led to believe it was dealing with Dr. Pedro Bosch, based on a nine-page application filed by the clinic. A source familiar with Bosch's operation, said, however, that the form was filled out by Ricardo J. "Ricky" Martinez, who is listed as the clinic's contact and served as its chief executive officer. Martinez, who also is named in the MLB lawsuit, several times has hung up on a reporter when asked for comment. A search of Pedro Bosch's medical license showed it active and clean. At the time, no one knew his son, Anthony Bosch, was operating behind the scenes.

"Orders we were getting were from Pedro, not Anthony," said David Bonfa, the client manager who oversaw the Biogenesis account for Hallandale Pharmacy. "I don't even know who that is."

However, confirming who actually signs a prescription form -- in this case, whether dad, son or perhaps a third party -- is a dark hole and something rarely addressed by pharmacies or even state health officials.

"There is only so much we can do to prove a signature is the right signature," said Rabbani, the pharmacy co-owner. "It is one professional to another. A lot of assumptions are made in general on every prescription ever presented to a pharmacist. So you never know."

Hallandale Pharmacy officials, though, maintain the relationship with the clinic went routinely for a couple of months, during which time Biogenesis submitted prescriptions to have substances compounded for 12 patients. Rabbani says the red flag that eventually ended the relationship came in the form of a prescription seeking nandrolone, an anabolic steroid. Rabanni would not describe any of the patients for whom Hallandale filled prescriptions, citing medical privacy laws, and would not say who the nandrolone was for, but he said he knew there was no legitimate medical use for the drugs.

Bonfa, who oversaw the account, called Biogenesis after receiving the request and recalls speaking with a female staffer, telling her: "'No, no, this is not happening here. We work too hard to police this industry. Just the fact I see this on the script I need to close the account.'

"They weren't too happy about that. That is for sure."

According to Carpman, Bosch has made the rounds at several South Florida wellness clients as an adviser. Bosch has also described himself in public records as a biochemist. He does not have professional licenses, but when asked if Bosch "knew his stuff," Capman said, "Yes, he did."

"I noticed he has a lot of patients, people who trust him," Carpman said of Bosch. "The problem with anti-aging medicine is it is not well regulated … I am a doctor. I am a real doctor. And I don't want to be involved with these things.

"Tony said he is an adviser. But people call him doctor. And he has a lab coat. He acts like a doctor, but he is not a doctor."

Carpman said at one point he went so far as to tell Bosch, "Listen Tony, you're not a doctor."

Yet sources say Bosch regularly signed prescription forms, diagnosed and treated clients, provided prescriptions for clients who had not been examined by a doctor and ordered prescription drugs sent to friends, and then had them delivered to some of the athletes he worked with.

The legitimate element to Bosch's now-shuttered practice has been his 75-year-old father, Pedro Publio Bosch, a licensed physician who was listed as the clinic's medical director.

Pedro Bosch did not respond to multiple messages left at his home or with his office staff, housed in a separate professional building several miles from his son's clinic.

Records from the former Biogenesis clinic include a prescription purportedly signed by Pedro Bosch in the name of a 53-year-old male patient for six tubes of a cream containing 20 percent testosterone, almost 15 times the concentrate of Andro Gel and other creams prescribed for low testosterone. Such high concentrates are normally associated with athletic enhancement, industry sources told "Outside the Lines." The prescription was written last July 9 to a compounding pharmacy and was to be delivered to the Biogenesis clinic.