Researchers Combat Fraud in Online Health Studies with New Guidelines

The shift towards virtual health research during the COVID-19 pandemic has increased the risk of fraudulent participation in clinical trials. A new study from the Boston University School of Public Health (BUSPH), led by Michael Stein, chair and professor of the Department of Health Law, Policy & Management, outlines methods researchers can employ to identify and prevent such fraudulent activity. The findings, published in the Journal of Medical Internet Research, offer a detailed checklist designed to help investigators recognize suspicious behavior before enrollment in online studies.

The report emphasizes a dual approach combining automated and manual actions during the prescreening, screening, and enrollment phases. By implementing this strategy, researchers can mitigate the risk posed by individuals driven by financial incentives to misrepresent their eligibility or enroll multiple times. “Modest financial remuneration is a cornerstone of most studies, important for recognizing participants’ time and effort, while also helping to boost engagement and retention,” explains Kara Magane, senior director of research operations at BUSPH.

The rise of online research has opened doors for participants who are often underrepresented in traditional studies. “Online research has lowered barriers to participating in research, particularly for people with stigmatized diagnoses, such as HIV,” notes Robert Siebers, a research coordinator at BUSPH. This accessibility contributes to higher privacy and comfort levels for participants, but it also increases the potential for fraudulent behavior.

Identifying Fraudulent Participants

The study highlights the experience of BUSPH researchers during two linked online trials focusing on HIV. While screening participants for the trials, the team discovered that ten individuals had fraudulently enrolled. This was prompted by a research assistant noticing that one participant appeared suspiciously similar to another individual interviewed days earlier. Following this incident, the team established a checklist to enhance their screening process and ultimately identified an additional 37 fraudulent participants.

Researchers should look for specific indicators of fraud during the prescreening process. These include patterns in email addresses, ZIP codes that do not match participants’ stated residences, and similar levels of physical activity among multiple participants. During the screening phase, signs of concern may include participants who enroll multiple times or provide unusually quick or predictable responses to questions.

To mitigate these risks, the researchers adapted their study protocols to include video screenings, where they could monitor participants’ appearance and behavior. They also suggested that researchers request, but not mandate, photo identification during these sessions to verify identities while respecting privacy concerns.

Implementing Effective Solutions

Automated methods, such as IP address identification systems and bot detection tools, can also play a vital role in early fraud detection. However, these technologies often require financial investments that may not be feasible for all research teams. The study advocates for coordination with institutional review boards (IRBs) to integrate fraud prevention measures into research workflows.

“IRBs and funding agencies can play an important role by recognizing fraud prevention as an integral part of research workflows, particularly for online studies,” asserts Magane. They can encourage researchers to incorporate fraud detection strategies into their protocols, ensuring resources are allocated for these efforts.

Stein, the study’s senior author, emphasizes the need for heightened awareness among researchers regarding the prevalence of fraudulent participants in virtual studies. “From the moment of planning an online study through the participant recruitment phase, researchers need to be alert to the possibility that bad actors can ruin the reliability of their findings,” he states.

As the landscape of health research continues to evolve, addressing the risk of fraud remains a crucial consideration. The guidelines established by the BUSPH team provide a framework for researchers to safeguard the integrity of their studies in a digital environment. For more insights, see the full study by Robert Siebers et al., titled “Lessons Learned Identifying and Controlling Fraudulent Participation in Online Randomized Trials,” published in the Journal of Medical Internet Research in 2025.