<p>The United States Food and Drug Administration Good Clinical Practice inspections play a critical role in safeguarding the rights, safety, and welfare of participants, verifying trial data, and ensuring regulatory compliance. Clinical trial fraud poses a serious threat to data integrity, undermines the reliability of regulatory decisions, and can jeopardize the protection of trial participants. This paper presents a case study of clinical trial fraud uncovered during preparations for a Food and Drug Administration inspection. It details the fraudulent activities committed, their impact on data integrity, and the consequences for the marketing application, and offers lessons learned and insights for preventing and detecting fraud in clinical trials. It emphasizes the application of Quality by Design principles by identifying critical factors that underpin clinical trial quality and designing and conducting the trials to protect those trial attributes. Additionally, it highlights the importance of risk-based strategies in monitoring, trial oversight, and the design and management of electronic systems. It also underscores the importance of reporting suspected clinical trial fraud to the Food and Drug Administration promptly. In this case, the Sponsor’s delay in reporting the fraudulent activities postponed the Food and Drug Administration’s investigation and ultimately extended the Prescription Drug User Fee Act timeline by three months.</p>