It's not fake in the same way it's talked about fake balsamic vinegar in this article.
Botulism can survive boiling, but not pressure cooking, which is only a little bit hotter, And below the point which oils are destroyed.
When you package anything, whichever department of ag you’re regulated by analyzes your ingredients and process to make sure you get a certain log reduction of any pathogens of interest. If there’s any risk at all, you have to have all of this greenlit by a process authority. (Oddly, Cornell is the 800 lb gorilla of that market, a huge chunk of packaged food in the US paid them for it.)
If someone is packaging real truffle oil anywhere in the US, and assuming botulism is a pathogen of interest (which I don’t know but does sound sensible) there’s definitely a kill step. I’ve never worked with mushrooms or any recipes that have low acid, so I don’t know what it is in this case. But I’m sure there is one.
Corollary: if you have a truffle not in season, it's definitely a fake. If you have a truffle in season, it's still probably a fake. Often it's a Chinese one, which tastes of nothing, with fake truffle flavour added. If you eat a naturally tasty truffle, you might not recognise it, nearly everyone has only ever eaten fakes.
I remember having fake truffle fries shortly after real truffle fries and boy the difference so big, I don't know why fake truffle just didn't create it's own label.
As for different things, about 7 years ago in LA there was as huge wine counterfeit operation bust. Expensive bottles were filled with cheaper wine, re-corked and sold. This is why expensive bottles now "destroyed" one way or another.
Point is - easier to sell and fewer troubles.
Real 100 year old Balsamic vinegar is $200/oz though: https://giusti.com/products/giusti-100-reserve