At least 70% of Americans use online reviews on sites like Yelp, Google, RateMDs and HealthGrades to help find healthcare providers, according to a 2020 survey from Software Advice, a consulting firm. But there’s a huge problem with that: an untold number of online reviews on these sites are fraudulent.
One recent analysis of four million reviews of healthcare and non-healthcare providers across sites including Google, Yelp and Facebook by the software service The Transparency Company, found that fake reviews were rampant. Google Reviews had the highest rate of fake reviews: 10.7%. Yelp followed with 7.1% and Facebook had 4.9%. . In fact, there’s an entire underground industry dedicated to connecting healthcare providers and other businesses with people who will write them positive — and fabricated — reviews. And all these fake reviews could be costing Americans billions of dollars in wasted fees and copays, not to mention time and energy. ClearHealthCosts spoke with experts and savvy patients about the best ways to avoid falling for these fake reviews.
How many fake reviews are out there?
“I just do not trust online reviews, period,” Kay Dean said. “There are just too many fake ones.”
Dean operates Fake Review Watch, a watchdog site that investigates and documents healthcare and non-healthcare businesses using fake review services online. Her work has formed the basis of investigations published by outlets including VICE, NBC and Reveal, and she publishes case studies on her YouTube channel. Dean previously investigated fraud for the U.S. Department of Education.
Five years ago, Dean visited a new psychiatric provider whom she had chosen largely based on glowing online reviews, only to have a terrible experience and later discover that those reviews were faked. She told ClearHealthCosts in a Zoom interview that given the level of fraud she’s uncovered as just a one-woman operation — thousands of fake reviews — she now recommends that nobody take online reviews seriously.
Dean has even found fake reviews on the Better Business Bureau, and she noted that healthcare-specific review sites like HealthGrades and Vitals are so opaque — you can’t click on a user’s profile to see what else they’ve reviewed, for one — that they’re functionally useless.
When providers resort to buying reviews to attain the coveted five stars, it’s shamefully easy to do. There are websites where they can buy reviews like any other e-commerce product. It’ll cost $500 for ten positive Yelp reviews from one website, which touts its search-engine-optimized reviews and use of local area profiles. And there are Facebook groups where businesses can swap reviews for just $5 each, Dean has documented.
How did we get here? Algorithms and profit
Fake reviews are a problem rooted in a profit-driven healthcare system in which everything — including our health — is a commodity. ProPublica reported that some providers are so invested in having high-star reviews that they’ve gone so far as to divulge personal medical information when responding to negative reviews, violating the Health Insurance Portability and Accountability Act, or HIPAA. Some have sued patients for leaving a negative review. In Dean’s case, when she left an honest review about the negative experience with her former provider, they impersonated a lawyer to get her to take it down.
And while Big Tech platforms have begun to flag COVID-19-related disinformation, fake online reviews — essentially another form of health disinformation — don’t get as much attention. The most an offender who’s discovered to have faked it may get on Yelp is a Consumer Alert that appears for just 90 days; or Google could delete the fake reviews with no posted warning to show readers if a provider did something unethical.
Why? Because there’s no incentive to crack down: platforms make money by hosting businesses and harvesting consumers’ data. And businesses want to get good results from the algorithms that drive online traffic by considering star-ratings and reviews. Evidence of widespread fraud, like warnings that could turn customers away, or banning a business, would hurt the bottom line — both for the healthcare provider, and for Big Tech.
Of course, the one foolproof way to avoid getting tricked by a fake review is not to consult reviews at all. Dean, the investigator, strongly recommends speaking to real people, asking trusted friends and family for their recommendations, and getting referrals from current or previous providers. She warns that reading reviews, even critically, isn’t adequate due diligence — especially for something as high-stakes as one’s health.
If you think you’re onto a fake review, don’t look at it in isolation, but look at a sample of reviews for patterns, like:
- Are there common turns of phrase and specific, detailed or effusive language shared across the reviews?
- Did all these positive reviews appear in a batch, within the same day or days of each other?
- Did the same people leave reviews at many of the same businesses as each other? Especially if it logistically doesn’t make sense: say, multiple people having patronized the same dentist in San Diego, landscaper in Boston, and donut shop in New Orleans.
And if you have time to be an internet sleuth, there are other ways to evaluate your prospective providers’ credibility:
“I Google them to death,” said Sarah Hoover, a 32-year-old living in Washington.
After experiencing years of medical gaslighting from doctors as she dealt with ovarian cysts and heavy bleeding, Hoover determined to never again go to a doctor that she didn’t know anything about. Now, she often starts with a list of referrals. While she does take a look at online reviews and ratings, she assumes that the highly positive and highly negative ones could be outliers or fakes, so she reads many to get a more representative sample. And she doesn’t bother with sites that only show starred ratings without user information.
Research beyond review sites
But Hoover makes sure to go beyond review sites: she recommends looking up prospective providers on Facebook, Twitter or other social media to see if their posts raise any red flags ethically or make her uncomfortable. She’s even tracked down academic articles that providers have published, which you can do using sites like Google Scholar. In one case, she dug up a therapist’s disciplinary record. (ProPublica has a guide on how to look up a doctor’s license and request disciplinary documents for every state, but be warned — most states require making at least a phone call; a couple even require you to file a Freedom of Information Act request!)
“I spent probably three hours Googling everything I could find about every dentist in a ten-mile radius,” Hoover told ClearHealthCosts in a Zoom interview, about her most recent research session. “And it worked out! I have very clean teeth now.”
Ultimately, increased wariness isn’t a substitute for meaningful action from regulators and Big Tech platforms. Dean’s investigations into fake reviews take hours, meticulous record-keeping and data analysis. That’s obviously not the kind of time or resources that the average American has. But she says if we can’t shake the habit of reading online reviews, we should at least stop treating them as though they’re reviews at all:
“Approach it with a mindset of — I’m just reading advertising,” she said. “If you think this is advertising, then how valuable is that in making a decision? Are you going to use that as a basis to select a medical provider?”