Fraud in procurement of medical equipment

Dr M, the Chief of Service of the Paediatric Department of a public hospital, asked David, the Department Operations Manager, to mark up the quotations of other companies so that he could secure the contract of the medical equipment to his girlfriend’s company.
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Fraud in procurement of medical equipment
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Dr M, the Chief of Service of the Paediatric Department of a public hospital, has the approving authority for purchases not exceeding $100,000. His girlfriend Phoebe is a sales manager of a large medical equipment company.

Recently, David, the Department Operations Manager, recommended a replacement of a medical equipment and the sourcing was in progress. As Dr M knew that Phoebe was being pressured by her boss to secure more business for the company, he offered to help her.  After going through the quotations obtained by David, Dr M found that the price quoted by Phoebe was not the lowest.  He thus asked David to mark up the quotations of other companies so that he could secure the contract of the medical equipment to Phoebe’s company.   In order to please Dr M, David agreed to the proposal.

Case Analysis

David would violate Section 9(3) of the Prevention of Bribery Ordinance for manipulating quotation breakdown to deceive his employer i.e. the Hospital Authority (HA).  Dr M, who instructed David to take part in the fictitious quotation plot might also be charged with an offence of conspiracy to defraud.

Dr M might face disciplinary action taken by the Medical Council of Hong Kong and his fitness to practise might be questioned.

At the same time, the HA would also take follow-up action against Dr M and David who might breach the HA’s code of conduct which requires the procurement of goods to be the best value for money in terms of price, quality, delivery time and service.

Also, Dr M should, as far as possible, avoid any actual and perceived conflict of interest. When a situation of conflict of interest cannot be avoided, he should as soon as possible declare all relevant details of such situation to his organisation, i.e. his relationship with the sales manager of the potential supplier.

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Hidden agenda in sponsorship

During the procurement of equipment for oculoplastics, Billy, the sales director of a potential supplier, asked Dr E, a consultant ophthalmologist in a public hospital, to comment favourably on the equipment produced by his company.
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Dr E is a consultant ophthalmologist in a public hospital who is often involved in the procurement of expensive medical equipment for his department.  The procurement department of the hospital will seek Dr E’s views while drafting the specifications and in the course of purchase.   He has a strong influence on the final selection of supplier through his assessment on the performance of the equipment.

During the procurement of equipment for oculoplastics, Billy, the sales director of a potential supplier, asked Dr E to comment favourably on the equipment produced by his company.  He proposed to pay for the passage and accommodation for Dr E to visit the company’s laboratory in New  York  and  take  the  convenience  to  attend  an  important  medical conference there.   After the trip, Dr E recommended the hospital to offer the contract to Billy’s company.

Case Analysis

Dr E would violate Section 4 of the Prevention of Bribery Ordinance as he accepted an advantage i.e. the sponsorship for visiting the company's laboratory and attending a conference without  the  permission  of  his  employer,  and  in  return  recommended  the medical  equipment  of  Billy’s  company  to  the  hospital.    Billy  would  also commit an offence of corruption for offering the bribe to Dr E.

Dr E might breach Section 15.1 of the Code of Professional Conduct issued by the Medical Council of Hong Kong (Oct 2022) which specifies that doctors should avoid accepting pecuniary inducement from commercial firms that might compromise the independent exercise of their professional judgement.

According to the Hospital Authority's (HA) guidelines on acceptance of donation and sponsorship, overseas site visit relating to the selection of medical equipment before or during tendering exercises should be funded by the HA and should not be sponsored by any of the potential vendors.  In any case, HA employees should not solicit or accept, directly or indirectly, any advantage or gift which would, or might reasonably be seen to, compromise their integrity or judgement or influence the discharge or non-discharge of their duties and responsibilities.

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Accepting rebates from diagnostic laboratories

Shortly after starting his private practice, Dr C was approached by Ms WONG, the proprietor of a medical laboratory, who requested for the referral of all his patients to her. Ms WONG suggested that an arrangement could be made for a sum to be offered to Dr C by the laboratory for each patient referred.
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Shortly after starting his private practice, Dr C was approached by Ms WONG, the proprietor of a medical laboratory, who requested for the referral of all his patients to her.   Ms WONG suggested that an arrangement could be made for a sum to be offered to Dr C by the laboratory for each patient referred.   She emphasised that it was in no way unfair to the patients since they had to do the tests somewhere in any case. She also said that a number of other doctors in the same building had already made such arrangement with her.

Prior  to  the  referral  of  patients  to  Ms  WONG‘s  laboratory, their agreement was brought to light by the nurse of Dr C’s clinic and the case was then reported to the ICAC.

Case Analysis

A principal and agent relationship exists between Dr C and his patients. As such, Dr C would breach Section 9 of the Prevention of Bribery Ordinance (POBO) by accepting rebates from Ms WONG for referring his patients to her laboratory if Dr C did not have the permission from his patients.

Although the “under-the-table” dealing was not carried out by Dr C and Ms WONG, they would still be liable to prosecution.   Under the POBO, both parties can be found guilty of an offence when the agreement on solicitation and acceptance of advantages have been reached even though the purpose of bribery has not been carried out.

Dr C might also violate Section 14.1 of the Code of Professional Conduct issued by the Medical Council of Hong Kong (Oct 2022) which prohibits doctors from receiving rebates from diagnostic laboratories for referring patients.

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Corruption in the assessment of medicine

The CEO of a pharmaceutical company offered company shares to Dr A for his assistance in writing a favorable report for a new drug…
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Dr A was a consultant of the Clinical Oncology Department in a public hospital.  His assessments of the effectiveness of medicines had a great impact on the clinical value as well as the future market value of the medicines.  Dr A attended the annual dinner of a pharmaceutical company on behalf of the hospital and met Terry, the CEO of the company.

They maintained close ties after the dinner and Terry always treated Dr A lavishly.  Lately, Terry invited Dr A to a dinner at a private club and he mentioned to Dr A that his company had recently developed a new antitumor drug, and the assessment of the effectiveness of the drug happened to be conducted by Dr A’s team.  Knowing that Dr A was responsible for the final assessment report of the drug, Terry requested Dr A to give a favourable  assessment result in the report.  Terry suggested to offer his company’s shares to Dr A in return.  Dr A found this an attractive offer as he had been planning to retire in five years.

Case Analysis

Dr A was a public servant as he is employed by a public hospital under the Hospital Authority. Terry had breached Section 4 of the Prevention of Bribery Ordinance (POBO) for offering Dr A an advantage, in the form of company shares as a return for Dr A’s favourable assessment result in the report . Dr A would also breach the POBO if he accepted the advantage without the permission from the Hospital Authority.

Although entertainment does not fall within the definition of advantage under the POBO, public servants should avoid accepting any lavish, unreasonably generous or frequent entertainment, as it may put them in an obligatory position in the discharge of official duties and compromise their impartiality or judgement.

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Misuse of proprietary information

A product engineer of a medical equipment company decided to develop an electronic thermometer for his employer based on the design of a similar product in his previous employment disregarding the confidential agreement signed.
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Anson, a product engineer at a medium-sized company, was the designer of an innovative electronic thermometer that later became the bestselling product of the company.  He left after his company was acquired by another company.

Later, Anson joined a medical equipment company which used to be a major competitor of his former employer.  He learnt that they intended to develop a new electronic thermometer.  He also noticed that a slight modification of the electronic thermometer he designed for his former employer could serve as a new product. In order to impress his new employer, Anson decided to design a new thermometer based on the product of his old company, neglecting the non-disclosure agreement he signed with his former employer on product information.

Case Analysis

What Anson did was a breach of trust of his former employer and he may face lawsuits from them for infringing intellectual property rights and breaching the non-disclosure agreement signed.

Anson may contravene the Rules of Conduct of the Hong Kong Institution of Engineers (HKIE) if he is a member of the institution, which prohibit an engineer from making use of proprietary confidential information for personal gain.  When working with new clients or changing employment, an engineer has a moral obligation to honour confidential and proprietary information gained from his previous employment, particularly the specific business or technical information from clients or employers.

The Rules of Conduct of HKIE also require an engineer to offer complete loyalty to his employer, past and present, in all business affairs and discharge his duties with integrity and in accordance with the highest standards of business ethics. An engineer is expected to properly credit the contributions of others in engineering practice.

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Lax security in maintaining medical records

A private detective offered $10,000 to a clinic assistant of a medical centre in order to obtain the medical record of the mistress of his client’s husband.
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Dr. K was a partner of a large private medical centre. Medical records of the centre were computerised to enhance storage efficiency and retrieval of patients’information. Every employee had access to the records since no password was required.

Robert, a private detective, was entrusted by his client Mrs. CHAN to keep surveillance on her husband who was suspected to have an affair with another woman. Discovering that Mr. CHAN’s mistress had paid frequent visits to Dr. K recently, Robert tried to seek assistance from the clinic assistant Eva to access relevant medical records. Robert agreed to offer Eva $10,000 as a reward for her help. Subsequently, Eva passed Robert a copy of the medical record of the mistress who had been confirmed pregnant.  Eva accepted the money from Robert in return.

Case Analysis

Both Robert and Eva might have breached Section 9 of the Prevention of Bribery Ordinance for offering and accepting bribes.  It was unlikely that Eva’s employer would permit her to accept an advantage (i.e. $10,000) for disclosing patients’ information to a third party. In addition, Eva might have committed an offence of accessing the computer with criminal or dishonest intent, contrary to Section 161 of the Crimes Ordinance.

Since Dr. K and his partners failed to adopt security measures to protect patients’ information, they might have liabilities under the Personal Data (Privacy) Ordinance which requires appropriate security measures to protect clients’ personal data.

Section 1.1.3, 1.1.4 and 1.1.5 of the Code of Professional Conduct issued by the Medical Council of Hong Kong (Oct 2022) also requires doctors to take every step to strengthen the control system to protect patients’ information from misuse.

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Fraudulent insurance claims

Dr J is a general practitioner in private practice. On one occasion, his friend Tony, an insurance agent, suggested to him a plan for earning quick money…
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Dr J is a general practitioner in private practice.   On one occasion, his friend Tony, an insurance agent, suggested to him a plan for earning quick money.   The Personal Accident Insurance Policy (PAI) offered by his company would provide insurance compensation for an injury caused by an accident resulting in death, permanent or temporary disability to an insured.   All claims under the PAI had to be supported by a form issued and signed by a registered doctor in Hong Kong.   Tony knew many construction workers and, as a first step, he  would  suggest  to  them  to  buy  PAI  policies  from  him.    These individuals would make claims later, even though they just suffered from minor injuries.   What Dr J could help was to exaggerate the seriousness of the injuries when filling in the worker's claim forms as the attendant doctor, thus resulting in higher compensation payments.   The “profit” could then be split among all parties.

Case Analysis

Dr J, Tony and the construction workers would commit an offence of conspiracy to defraud by colluding in making bogus insurance claims to deceive Tony’s insurance company for personal gain.

Dr J might violate Section 26.3 of the Code of Professional Conduct (Oct 2022) issued by the Medical Council of Hong Kong for issuing documents containing untrue information.

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Common trade practice is not a defence

Andrew was the chief accountant of a large trading company. He discovered a number of fraudulent and corrupt activities involving senior sales representatives and their mainland clients and such activities were condoned by the senior management.
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Andrew was the chief accountant of a large trading company.  Due to keen competition, the business of the company deteriorated substantially.  To improve the situation, the company attempted to invest in the Mainland.

When reviewing the books and bank statements, Andrew found that there was evidence of fraudulent activities involving some sales representatives. Andrew discovered that there were no supporting documents for some cash payments claimed by the sales representatives.  When asked for explanations, the sales representatives replied that those expenses had been incurred for the purpose of building up new businesses in the Mainland.  They further explained that the offering of commission to agents of business clients was a common practice.  When consulting the Marketing Director who was a long serving staff of the company, Andrew was told that the expenses were approved by  the Marketing Director personally. 

With no choice, Andrew went to see the Vice-president.  The Vice-president pacified Andrew and told him that in real business life, the company had to tolerate some minor variations in order to get the job done.

Next day, a cheque was placed on Andrew’s desk and the phone rang.  It was the Marketing Director.  Andrew was asked to sign the cheque and was told that it would be deposited in a designated Hong Kong bank account belonging to a buyer of a firm in the Mainland.  The arrangement enabled the buyer to pay for his various expenses while on business in Hong Kong.  He further suggested that the sum could be paid by an overseas subsidiary of the company.

Although Andrew knew that the client was very important to the company, he suspected that the payment might be unlawful.

What should Andrew do?

Case Analysis

The sales representatives committed an offence under Section 9(3) of the Prevention of Bribery Ordinance (POBO) offence if they had submitted false documents i.e. claims of commissions or entertainment expenses to deceive their principal i.e. the company.   

Furthermore, the offering of illegal commissions to agents of business clients with a view to obtaining or securing business might constitute a bribery offence under the POBO.   Agents of clients should obtain permission from their principals, i.e. their employers, for accepting advantages or commissions in relation to their work.  As approval should be given by the principal of the acceptor not the offeror, the Managing Director’s approval on the expense payments would not be considered the principal’s approval in this case.  

Although the clients were located in the Mainland, if any part of the act of bribery (including offering, soliciting or accepting a bribe) takes place in Hong Kong, the case may still be pursued by the ICAC under the POBO.  In any case, customary trade practice could not be a defence in any proceeding for a bribery offence under the POBO.  

Andrew should bring the issues to the attention of the company management and avoid involve in any acts that might call his integrity and professionalism into question. He should take into account his own views on ethics and legality and offer advice to the management if there were better alternatives.  

If corruption involving senior management was suspected, and all his attempts to find legal and ethical alternatives were rejected, then Andrew should consider resigning from the company and refuse to carry out any illegal transactions. He should consider reporting corruption to the ICAC and other crimes to the police.

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False accounting

Mike was the voluntary auditor of the parent-teacher-association (PTA) of his son’s school. Considering his son’s academic and behavioural problems at school, Mike was hesitant to report the suspected fraud related to the school accounts…
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Mike, a certified public accountant, was the voluntary treasurer of the parent-teacher-association (PTA) of the private school which his son attended.  Though the PTA had an annual expenditure budget and raised substantial funds each year, no formal accounting reports had been made by the school.  The new PTA Chairman thought it was time to clarify the current financial position of the association and asked Mike for assistance.

When going through the accounting records, Mike discovered several red flags: the actual expenditures were inconsistent with the approved budget; the cash balance fluctuated without explanation; and the cash inflows from fund-raising events did not match with the accounting records.

Mike then approached the school secretary, who looked after the PTA’s accounts, for clarification.  However, the school secretary repeatedly gave vague and evasive responses. As Mike did not have access to the school’s accounts and lacked important information to determine the cause of the problems, he suspected that a fraud might be involved. Meanwhile, the school principal had recently indicated concerns on the academic performance and constant school behavioural problems of Mike’s son.

Mike was uncertain if he had any professional obligations as a voluntary treasurer in the PTA.  He was also worried whether reporting the suspected fraud would cause the school any trouble and affect his son’s interests in school. What should Mike do?   

Case Analysis

The school secretary might have committed an offence under Section 9(3) of the Prevention of Bribery Ordinance (POBO) if he had submitted false documents, i.e. false PTA accounting records, to deceive his principal, i.e. the school.     

Though being a voluntary treasurer, Mike still has professional obligations to the PTA.  Mike should bring the issue to the attention of the PTA or consider reporting the suspected fraud to the school or law enforcement authorities. He should also avoid involve in any acts that might call his integrity and professionalism into question. He must take into account his own views on ethics and legality and offer advice to the PTA if there were better alternatives.  

As a professional accountant serving as a volunteer, Mike should always observe the Code of Ethics of Professional Accountants and comply with the fundamental principles of integrity, objectivity, professional competence and due care and avoid any conflict of interest. 

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Professional Integrity of Accounting Professionals

Billy’s trading company was a major client of Jimmy’s CPA firm. Facing a difficult time, Billy asked Jimmy to manipulate the financial position of his company in the year-end audit to facilitate his obtaining credit facilities from a bank…
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Jimmy and Billy studied Accounting and Finance in the same university and became very good friends.  After graduation, Billy started his own trading business.  His company, B&B Co. Ltd., had been expanding very fast and achieving a huge annual turnover.  Jimmy pursued his career in accountancy and worked hard to become a partner in a CPA firm.  Naturally, B&B Co. Ltd. became one of the major clients of Jimmy's firm, contributing to 20% of its professional income.

This year, B&B Co. Ltd. was facing a very difficult position.  Apart from losing a few major customers, a significant loss was discovered after Jimmy's firm completed the year-end audit for B&B Co. Ltd.

Jimmy was invited to lunch by Billy.  Over the lunch Billy told Jimmy that he was negotiating a big order.  If he could successfully apply for a line of credit with a bank to handle the order, B&B Co. Ltd.'s position would turn around. By then, even more services would be needed from Jimmy's firm. 

However, he was worried that if the bank was aware of B&B Co. Ltd.’s current financial position, it would not grant credit facilities.  Billy then asked Jimmy to use whatever device to improve the financial position of his company and promised to duly reward Jimmy with a luxurious car after overcoming this hurdle.  If Jimmy refused his request, he had no choice but to appoint another CPA firm next year.

Case Analysis

The offering of “reward” by Billy as an inducement for Jimmy to misrepresent the financial position of B&B Co. Ltd. was a breach of Section 9 of the Prevention of Bribery Ordinance (POBO).  Jimmy should refuse Billy’s offer and make it clear to Billy that while B&B Co. Ltd. was an important and valued client of his firm, no financial inducement or veiled threat would cause him to compromise his independence and professional integrity in connection with either the company's forthcoming audited financial statements or any other professional engagements carried out for B&B Co. Ltd.

Jimmy might consult a fellow partner at this stage in considering his alternative responses to this sensitive situation and in clarifying his own professional responsibilities in the circumstances, although remaining mindful at all times of the need to preserve client confidentiality.  In the event that Jimmy had no appropriate internal channel for such consultation, he might consider consulting the Hong Kong Institute of Certified Public Accountants.

As Billy’s close friend, Jimmy should explain to Billy that the use of “whatever device he could to improve the financial position of B&B Co. Ltd.” was inappropriate, and that he and his firm would endeavor to help the company overcome the current challenges by legitimate means.

If Billy was unwilling to change his position and insisted on carrying through his threats, Jimmy should point out that, having substantially completed the audit that they were engaged to perform, his firm would propose to issue a qualified report if B&B Co. Ltd.’s financial statements did not give a true and fair view. 

Having fulfilled their statutory responsibility by reporting to the shareholders, Jimmy should explain that his firm would tender their resignation.  Details of these circumstances would also be given to any proposed successor firm of auditors in etiquette correspondence.  In the event that B&B Co. Ltd. attempted to remove Jimmy's firm from office, Jimmy should explain that he would consider making similar representations to the shareholders as entitled under the Companies Ordinance.

Jimmy was suggested to report the attempted bribe to the ICAC to safeguard his own interests.  

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