Contract analysis to identify coordinated misreporting

A Brattle team advised the US Department of Justice in an FCA investigation into alleged market-wide coordination of improper fee arrangements between pharmacy benefit managers (PBMs) and plan sponsors. The investigation focused on allegedly manipulated and misreported fees that were supposed to be set at arm’s length. Brattle investigated whether indications of artificial pricing were common across PBMs as potential evidence of coordinated behavior in breach of regulations. To analyze the pricing, we created a structured database and extracted data to identify patterns in contract terms over time and across companies. The analysis informed a testifying expert’s evaluation of the fee arrangements in these contracts relative to customary contracts, the method with which these arrangements were reported, and the reporting requirements before the settlement.