How to Report Best Price Fraud
As pharmaceutical manufacturers alone have access to the proprietary information for the correct rebate amounts, this illegal scheme is a crime that can only originate with them. Almost all successful lawsuits against this sort of fraud have been qui tam cases built by whistleblowers with insider information. These relators have included pharmaceutical company employees, healthcare providers, wholesale purchasers, and private pharmacies. Company employees may become aware of erroneous Best Price data or of intentions to defraud the government, and business affiliates may receive improper offers in order to perpetuate the unlawful scheme.
Examples of this type of pharmaceutical scam are often not as straightforward as a company reporting a false Best Price to Medicaid. As more violations have been exposed and tried by the Department of Justice, unscrupulous companies’ tactics have become more sophisticated and varied.
Some companies have kept their fees artificially high by disguising their price discounts to private purchasers as processing fees, educational grants, financial investments, or other arrangements that effectively lower the cost of the purchased medications. In some cases, drug manufacturers have enlisted the help of private insurers, local pharmacists, and healthcare providers in their false reporting by providing kickbacks and other illegal monetary deals.