Best Price Fraud
Serving Clients Nationwide
Best Price Fraud is one of the most common types of pharmaceutical fraud perpetrated by drug manufacturers, but unfortunately it is also one of the most difficult to discover and prosecute. Often, Best Price Fraud cannot be addressed without the help of qui tam whistleblower lawsuits brought by those with knowledge of the fraudulent price reporting. This is because under the current Medicare/Medicaid state rebate system, the responsibility for accurately reporting the Best Price available for a given drug rests with the very drug manufacturer who is affected by the rebates.
Defining Best Price Fraud
The Medicare Rebate Program is designed to ensure that the reimbursement rate Medicare and Medicaid pay for prescription drugs is not higher than the prices offered to other entities by the pharmaceutical manufacturer. Essentially, the goal is to give taxpayers (via Medicare/Medicaid) the lowest available price on prescription drugs provided under those programs. Under the Medicare Rebate Program, pharmaceutical companies are required to provide rebates to states to compensate for any drugs purchased above the manufacturer’s Best Price. The company reports its Best Price for a given drug to the Center for Medicare and Medicaid Services (CMS), which calculates the unit rebate amount and reports that amount to the state Medicare/Medicaid agency, which calculates the total rebate.
Clearly, there is great potential for fraud in this system as pharmaceutical companies have a huge incentive to falsify their Best Price reporting in order to decrease their overall rebate liability. Failure to accurately report the Best Price, which is supposed to include any discounts, grants, coupons, rebates, and other incentives offered to purchasers, constitutes pharmaceutical fraud under the False Claims Act.
Becoming a Whistleblower on Best Price Fraud
If you have knowledge of intentional Best Price underreporting, hiding discounts and kickbacks, or any other form of Best Price Fraud, this knowledge can be the bases for a qui tam lawsuit. Pharmaceutical companies who commit Best Price Fraud are essentially robbing taxpayers by stealing from Medicare and Medicaid. Whistleblowers who report Best Price Fraud are actually carrying out their duty to fellow taxpayers and providing an important public service. Therefore, whistleblowers are afforded specific whistleblower protections under the law and are eligible to receive a percentage of the amount the government recovers in a successful action.
The qui tam lawyers of Kenney & McCafferty have been helping whistleblowers report fraud and abuse for over fifteen years with a focus on protecting clients from retaliation and on maximizing whistleblower rewards. The lawyers at Kenney & McCafferty dedicated their practice almost exclusively to qui tam cases, enabling us to become one of the most high-profile qui tam law firms in the nation. As a result, we have represented whistleblowers in some of the largest recoveries in the history of the False Claims Act.
If you have knowledge of a fraud or false claim against the government, please contact our qui tam lawyers today. Kenney & McCafferty attorneys will consult with you about your case, without obligation. All communications with Kenney & McCafferty attorneys during these consultation services are confidential and protected by the attorney-client privilege.
