Types of Pharmaceutical Fraud
If you report Medicaid rebate drug fraud (best price fraud), you may be entitled to a whistleblower reward, as outlined in this website.
There are many ways drug companies cheat the government. One way is by under-reporting a drug manufacturer’s best price. Drug companies are required to give Medicaid the same lowest or best price as they sell the same drug to favored customers.
If you want former Justice Department Attorney Joel Hesch to evaluate in complete confidence to see if you have the right type of case to get a reward, then fill out the form at this link (click here) and Mr. Hesch will personally get back to you right away. If you want to read more about the $1.75 billion in whistleblower reward cases Mr. Hesch has handled click here.
More details about best price fraud
Drug companies must report to the government each quarter the best price the company sells each of its drugs to its best customer and then pay Medicaid the difference between that price and the price it had charged Medicaid for the drug. The rebates due from pharmaceutical companies are generally millions of dollars each quarter. Some companies lie or disguise the true lowest price charged, and thus cheat Medicaid out of millions of dollars in overpriced drugs. Other drug companies lie about the average wholesale price (AWP) or average manufacturer price (AMP) which affects the amount of rebates due the government under the Medicaid Rebate Statute. The government has paid hundreds of millions in rewards to citizens who reported this type of fraud.
Anytime a drug manufacturer conceals or falsely reports either its best price, AWP or AMP, it cheats Medicaid and should be reported.
Best Price violation for failing to aggregate or stack multiple rebates
An example of best price fraud is when a drug manufacturer fails to report its true lowest or best price by not aggregating or stacking rebates it pays to two or more unrelated entities when both rebates are needed to make the sale of a single pill to a single patient. A drug company cannot simply choose the single highest rebate paid to one of two entities. Under the Medicaid Rebate Statute and the Medicaid Rebate Agreement, a drug manufacturer must calculate best price as “the lowest price” is sells the drug to anyone in any pricing structure, and must take into account “cumulative discounts, rebates or other arrangements subsequently adjust the prices actually realized.” 56 Fed. Reg. 7049. In sum, a drug company must calculate best price as the amount it realizes and not simply the highest single rebate offered to one entity. It is the net price realized when making the sale of a single pill to a single patient. In other words, if a drug company must pay two rebates to two unrelated entities to make the sale, they both must be included in determining best price.
Click here for a more detailed article by the Hesch Firm explaining how failing to aggregate or stack discounts or rebates a drug company pays to two unrelated entities is a violation of the False Claims Act, and therefore must be included in the calculation of best price. Failing to do so means the drug manufacturer may have to repay millions of dollars to Medicaid, and a whistleblower may be entitle to a significant reward for reporting best price violations.
If you know of a pharmaceutical drug company cheating through Medicaid Rebate program fraud (for best price or any other fraud scheme) and are interested in a reward, fill out our fraud questionnaire.