The detection of clinical fraud is not easy. Some formal scheme is necessary particularly if approaches to the problem are going to be carried forward into a training programme. A scheme that has been found to work well in practice is to consider the detection of fraud in four distinct steps:
1 The visit, normally by clinical research associate, medical research associate, or medical adviser
2 The return trial materials
3 The case record forms, patient diary cards, etc.
4 The final report.
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