Glossary

AMP - Average Manufacturer Price
AUSA - Assistant U.S. Attorney
AWP - Average Wholesale Price
CIA - Corporate Integrity Agreement
CMS - Centers for Medicare & Medicaid Services
DOJ – Department of Justice
DRA - Deficit Reduction Act of 2005
FCA - False Claims Act
HCFA - Health Care Financing Agency
Medicaid Best Price
MFCU - Medicaid Fraud Control Unit
MRA - Medicaid Rebate Act
NAMFCU - National Association of Medicaid Fraud Control Units
OBRA '90 - Omnibus Budget Reconciliation Act of 1990
OIG – Office of Inspector General
TAF – Taxpayers Against Fraud
USAO – United States Attorney's Office

Average Manufacturer Price (AMP) - The average price paid to a manufacturer by wholesalers for drugs distributed to retail pharmacies. AMP is used in calculating Medicaid rebates to the States and not publicly available.

Assistant U.S. Attorney (AUSA) - An Assistant U.S. Attorney prosecutes criminal matters involving violation of federal law and represents the federal Government in civil matters, including qui tam whistleblower False Claims Act matters.

Average Wholesale Price (AWP) - A national average of list prices charged by wholesalers to pharmacies. AWP is sometimes referred to as a "sticker price" because it is not the actual price that larger purchasers normally pay.

Corporate Integrity Agreement (CIA) - The Department of Health & Human Services' Office of Inspector General (OIG) often negotiates compliance obligations with health care providers and other entities as part of the settlement of federal health care program investigations arising under a variety of civil false claims statutes. A provider or entity consents to these obligations as part of the civil settlement and in exchange for the OIG's agreement not to seek an exclusion of that health care provider or entity from participation in Medicare, Medicaid and other federal health care programs. These compliance measures seek to ensure the integrity of federal health care program claims submitted by the provider.

Centers for Medicare & Medicaid Services (CMS) - The federal agency that runs the Medicare program. In addition, CMS ensures that state Medicaid programs are run according to federal guidelines.

Department of Justice (DOJ) – The Washington, D.C. based federal agency that prosecutes criminal matters and represents the federal Government as plaintiff or defendant in civil matters.

Deficit Reduction Act of 2005 (DRA) – In February 2006, Congress enacted Section 6031 of the Deficit Reduction Act of 2005, S. 1932, which added section 1909(b) to the Social Security Act. The provision was passed to encourage States without False Claims Acts to pass their own versions of the federal law since the law included the provision that States with qualifying FCAs receive an additional 10 percent of Medicaid fraud awards.

False Claims Act (FCA) – Originally called the "Lincoln Law," the federal False Claims Act, originated during the Civil War, was designed to combat Union Army supplier profiteering. For most of its history, the FCA was used to fight defense industry fraud. In recent years, the law has been used in whistleblower lawsuits and health care to recover for false or fraudulent Medicare or Medicaid claims. The qui tam provision allows an individual to file an FCA case under seal and gives the Government has the right to join the action. If the Government declines to intervene, the same qui tam whistleblower may proceed on his or her own.

Formulary - A list of drugs covered by a health care plan.

Health Care Financing Administration (HCFA) - The Health Care Financing Administration (HCFA) was the predecessor of today's Center for Medicare and Medicaid Services (see CMS above).

Medicaid Best Price (Best Price) - The lowest price paid to a manufacturer for a brand name drug, taking into account rebates, chargebacks, discounts, or other pricing adjustments, excluding nominal prices. Best price is a variable used in the Medicaid Rebate Act to calculate manufacturer rebates owed to state Medicaid agencies. Prices charged to certain governmental purchasers are statutorily excluded from best price including prices charged to the Veterans Administration, Department of Defense, Indian tribes, the Federal Supply Schedule, State Pharmaceutical Assistance Programs, Medicaid, Public Health Service "340B" entities, and Medicare Part D prescription drug plans (starting in 2006). Best price data is reported by manufacturers to CMS but is not publicly available.

Medicaid Fraud Control Unit (MFCU) – The state-level agencies that investigate Medicaid fraud and part of the states' attorneys general offices. MFCUs were created by Congress in 1977 as federal and state-funded law enforcement entities to investigate and prosecute provider fraud and violations of state law pertaining to Medicaid fraud. MFCUs also are required to review complaints of resident abuse or neglect in nursing homes and other health care facilities.

National Association of Medicaid Fraud Control Units (NAMFCU) - The National Association of Medicaid Fraud Control Units (NAMFCU) was founded in 1978. Today all 50 federally-certified MFCUs are members of the association. Each unit is represented by its Director. There are six NAMFCU regions in the U.S.

Omnibus Budget Reconciliation Act of 1990 (OBRA '90) – Federal legislation that set rebate provisions for prescribed drugs under Medicaid per legislation known as the Medicaid Rebate Act.

Office of the Inspector General (OIG) –The Office of Inspector General of the U.S. Department of Health & Human Services ("HHS") protects the integrity of HHS programs and the health and welfare of those programs' beneficiaries. The OIG must report to the HHS Secretary and Congress any program and management problems and recommendations to correct them. The OIG's duties are carried out through a nationwide network of audits, investigations, inspections and other mission-related functions performed by its components.

Taxpayers Against Fraud (TAF) - Taxpayers Against Fraud and the Taxpayers Against Fraud Education Fund (TAFEF), http://www.taf.org, are organizations dedicated to assisting whistleblowers and their attorneys, to protecting the False Claims Act against attack by big business, and to educating the American people about the benefits of the False Claims Act's qui tam provisions.

United States Attorney's Office (USAO) – There are 93 federal districts in the U.S. In each the chief law enforcement officer is the U.S. Attorney whose responsibility includes prosecuting federal civil and criminal cases and defending the U.S. in cases filed in their districts.