Why Suppressing Bad Reviews Is an FTC Violation

Review suppression is an FTC violation that most telehealth brands commit without realizing it. The FTC's Rule on the Use of Consumer Reviews and Testimonials (16 CFR Part 465), finalized in August 2024 and effective October 2024, specifically prohibits a set of review management practices that have become standard in the health and wellness industry. If your customer success team only sends review requests to patients who reported a positive experience, you are likely in violation. If your platform shows a curated subset of positive reviews while hiding negative ones, you are likely in violation. If you have ever given a patient a discount or free service in exchange for a review, you are likely in violation.

The rule applies to any business that solicits, collects, or displays consumer reviews — which describes virtually every telehealth brand with a presence on Google, the App Store, Trustpilot, or its own website. Civil penalties for violations can reach $51,744 per violation as of the current adjustment schedule. More significantly, enforcement action often results in consent orders that impose multi-year compliance reporting requirements and restrict future review management practices.

What the FTC Defines as Review Suppression

The FTC's rule identifies five prohibited practices as forms of review suppression or manipulation. First, selectively asking for reviews — sending review requests only to customers you have reason to believe are satisfied — is prohibited because it systematically skews the review population toward positive ratings. If you use a "happy path" review funnel that routes dissatisfied patients away from the public review page and toward a private feedback form, you are engaging in selective solicitation.

Second, providing compensation — discounts, free services, account credits, or any other consideration — in exchange for a review is prohibited unless you disclose the incentive prominently within the review itself and do not condition the incentive on a positive review. The distinction matters: you can offer a discount that any reviewer receives, provided that fact is disclosed and the discount is not conditioned on a positive rating. You cannot offer a discount specifically to unhappy patients to encourage them to update a negative review to a positive one.

Insider Reviews and Employee Testimonials

The FTC rule also prohibits insider reviews — reviews posted by company employees, founders, or family members without disclosing the material relationship. In telehealth, this often manifests as providers or staff who are patients of the service writing reviews without disclosing their employment relationship. A nurse practitioner employed by your telehealth platform who writes a five-star review of the service on Google or the App Store without disclosing that they work for the company is creating an insider review in violation of the rule.

This applies retroactively to existing reviews. If you have reviews from employees or founders on public platforms, and those reviews do not disclose the material relationship, the FTC considers those reviews to be ongoing violations as long as they remain published. You may need to request that the reviewer update their disclosure or remove the review to come into compliance. This is an uncomfortable conversation many brands have never had with their teams.

Review Gating and Its Specific Prohibition

Review gating is the practice of asking customers how they would rate their experience before directing them to a public review platform. The logic: satisfied customers get sent to Google Reviews, unsatisfied customers get sent to a private feedback form. The FTC rule explicitly prohibits this practice. Even if you do not technically suppress negative reviews after they are written, systematically routing dissatisfied customers away from public review channels before they have the opportunity to write a review creates a misleading picture of your brand's reputation.

Many CRM platforms and customer success tools have offered review gating as a feature for years. The fact that this functionality exists in widely-used software does not make it legal. If your patient communication workflows include a pre-review satisfaction check that determines where the patient is directed, you need to change that workflow. All patients who receive a review request should be directed to the same public review platform, regardless of their pre-survey sentiment.

How Review Suppression Intersects with Telehealth Advertising

Review suppression has a direct connection to your paid advertising because the FTC's endorsement rules treat reviews used in advertising the same as testimonials. If you feature a five-star rating or specific patient reviews in your ads, and those reviews were collected through a gated process that systematically excluded negative reviews, then the advertised review data misrepresents your actual patient experience — which is a deceptive advertising claim under Section 5 of the FTC Act, separate from the review suppression rule itself.

This means that cleaning up your review collection process is not just a compliance step for the review platform — it protects the integrity of any claims you make in paid advertising about patient satisfaction, star ratings, or review volume. "Trusted by 10,000 patients with a 4.8-star average" is a material claim in an ad. If that 4.8-star average was achieved through review gating, the claim is substantiated on a misleading foundation. See the full framework for testimonial rules in telehealth advertising for how the FTC connects review data to ad claims.

What a Compliant Review Strategy Looks Like

A compliant review collection strategy sends review requests to all patients equally, without pre-screening for satisfaction. The request should direct patients to a single public review platform rather than branching based on sentiment. It should not offer any compensation for leaving a review, unless that compensation is clearly disclosed within the review and is available regardless of whether the review is positive or negative. Review requests should not coach patients on what to say — language like "if you had a positive experience, please share it on Google" is problematic because it selectively encourages positive reviews.

If you receive negative reviews, the compliant response is to respond publicly and professionally, not to incentivize the reviewer to update their rating. Offering a dissatisfied patient a refund or discount is a reasonable customer service action — but doing so in the context of asking them to reconsider their review rating is prohibited. Separate customer service from review management, and document that separation. The FTC endorsement rules provide the overarching framework that governs both reviews and testimonials in telehealth advertising.

Auditing Your Current Review Practices

The first step is documenting your current review collection workflow end-to-end. Where does the review request originate — patient success software, CRM, post-visit email? Does the workflow include any pre-screening step? Are review requests sent to all patients or only a subset? Do any review requests include any form of incentive, explicit or implied? Do you have any employees or founders who have written reviews of your brand without disclosing their relationship? Answering these questions honestly gives you the gap analysis you need to achieve compliance.

Most telehealth brands will find at least one of these practices in their current workflow. The good news is that each one has a compliant alternative that is not substantially more difficult to implement. Review gating can be replaced by universal review requests. Selective solicitation can be replaced by time-based or event-based triggers that apply to all patients. Incentivized reviews can be replaced by transparent, disclosed incentive programs that do not condition the benefit on a positive outcome. Making these changes takes a sprint, not a quarter — and the risk reduction is immediate.