Top doctor awards, paid badges and star ratings in practice advertising

Most practice owners have seen the email: congratulations, your doctor has been selected as a top provider, and a badge, a plaque and a press release kit are available for a fee. Some of these recognitions come from a real selection process. Some are closer to a product sold to anyone who pays. Patients usually cannot tell the difference from the badge alone, which is exactly why the way a practice uses an award in its ads and on its website matters.

This guide covers how the FTC treats awards, seals and rankings shown in advertising, when paying for one becomes a problem, how star ratings fit under the FTC rule on consumer reviews, what Google allows for review stars in search results, and a checklist to run before any badge goes on the website. For the professional ethics side, including how to handle words like best and top, see our guide to physician advertising rules. For designations, accreditation and center of excellence labels, see our guide to center of excellence and designation claims. For television and press logos shown as “as seen on” or “featured in”, see our guide to media badges on a practice website. For best, first, only and leading claims a practice makes about itself, see our guide to superlative claims in healthcare ads.

An award badge is an endorsement

The FTC Endorsement Guides define an endorsement as any advertising message that consumers are likely to believe reflects the opinions, beliefs, findings or experiences of a party other than the advertiser. The definition in 16 CFR 255.0(b) says the name or seal of an organization can be an endorsement, and that the endorser can be an individual, a group or an institution.

So when a practice puts a “Top Doctor” badge on its homepage, mentions a ranking in a Google ad or prints a seal on a mailer, it is using an endorsement. The Guides then apply to how that endorsement is used, and 255.1(d) says advertisers are subject to liability for misleading statements made through endorsements. The practice that displays the badge is the advertiser. It cannot treat the badge as someone else’s claim.

What the FTC expects from an organization that gives an award

Section 255.4 of the Guides covers endorsements by organizations. It says consumers see an organization’s endorsement as the judgment of a group, so the endorsement must be reached by a process sufficient to ensure that it fairly reflects the collective judgment of the organization. If the organization is presented as expert, it must use experts it recognizes as such, or standards it adopted beforehand that are suitable for judging the relevant merits.

A practice usually has no control over how an awarding body works. It does control which awards it chooses to display. Before using one, it is reasonable to ask the questions this section raises:

• Who decided? Is there a described process, such as peer nominations, a survey with a stated method or a review by named clinicians, or did the selection arrive with a sales offer?
• On what criteria? Are the standards published, and were they set before the selection, not written around the winners?
• Is the body presented as expert? A badge that reads as a medical judgment implies an expert evaluation. If no one with relevant expertise was involved, the badge may imply more than the process supports.
• What does it actually measure? An award based on patient survey responses, years in practice or peer votes says something different from one based on clinical results. The ad should not suggest more than the award measured.

When paying for the award is the problem

Paying money to an awarding body is not automatically deceptive. The Guides draw the line at whether the payment affects the result, and whether consumers would expect it.

Example 3 in 16 CFR 255.4 describes a review website that ranks products and accepts money from manufacturers in exchange for higher rankings. The Guides say such paid-for rankings are deceptive whether or not the site claims to be independent, that a manufacturer who pays for a higher ranking may also be held liable, and that a disclosure of the payments would be inadequate because the payments actually determine the rankings. The same example says a ranking method that rates products higher because of the seller’s relationship with the operator is also misleading.

The example is about headphones, but the principle carries over to a list of top practices or top doctors. If a place on the list, or a better place on it, depends on what the practice pays, displaying that list as a recognition of quality is the problem, and a small “sponsored” note does not cure it under this example.

A different situation is a fee for an evaluation that consumers would expect. Example 10 in 16 CFR 255.5 describes a company that paid a reasonable fee to a non-profit association to evaluate its product for a seal of approval. Because consumers would reasonably expect that marketers have to pay for that kind of certification, the Guides say using the seal without disclosing the fee would not be deceptive. The difference is that the payment covers an evaluation against standards; it does not buy the outcome.

Between those two ends is the common case: a selection that appears to be genuine, followed by an offer to license the badge, a plaque or a listing upgrade. Section 255.5(a) says a connection between the endorser and the seller that might materially affect the weight or credibility of an endorsement, and that the audience would not reasonably expect, must be disclosed clearly and conspicuously, and that disclosure is needed when a significant minority of the audience does not understand or expect the connection. Whether a licensing fee meets that test depends on the facts, so this is a question to put to counsel. If the selection itself was conditioned on buying something, treat it as a paid ranking and do not use it.

Old awards and borrowed claims

Two more parts of the Guides matter for how long and how loudly an award is used.

• Keep it current. Section 255.1(b) says an advertiser may use an expert endorsement only so long as it has good reason to believe the endorser continues to hold the views presented. A badge from several years ago shown without a year can suggest a current recognition. Showing the year, and removing awards the body has not renewed, keeps the claim accurate.
• Do not let the award say what you cannot. Section 255.1(a) says an endorsement may not convey any representation that would be deceptive if the advertiser made it directly. The FTC Health Products Compliance Guidance applies the same idea to health claims: advertisers should not make claims through expert endorsements that would be deceptive or could not be substantiated if the advertiser made them directly. A recognition for patient experience does not support an ad that implies better treatment results.
• Describe it accurately. Section 255.1(b) also says an endorsement may not be presented out of context or reworded so as to distort it. “Recognized in a regional patient survey” and “rated the best surgeon in the state” are different claims, even if the same badge is behind both.

Star ratings and the FTC rule on consumer reviews

Ratings are covered too. The FTC rule on consumer reviews and testimonials, 16 CFR Part 465, defines a consumer review in 465.1(d) and says consumer reviews include consumer ratings, whether or not they include any text. The parts of the rule most relevant to how a practice shows its ratings:

• No buying ratings. Section 465.4 prohibits giving compensation or other incentives in exchange for, or conditioned on, reviews expressing a particular sentiment, positive or negative.
• No insider ratings without disclosure. Section 465.5 covers reviews and testimonials by officers, managers and employees, and solicitations to their relatives, without a clear disclosure of the relationship.
• No house-run “independent” ranking sites. Section 465.6 prohibits a business from misrepresenting that a website, organization or entity it controls, owns or operates provides independent reviews or opinions about a category of businesses that includes its own. A “best clinics in town” site owned by one of the clinics on the list is the kind of thing this section addresses.
• No hiding the bad ones. Section 465.7(b) prohibits a business from misrepresenting that the reviews shown in the review section of its website represent most or all of the reviews submitted when reviews are being suppressed based on their rating or negative sentiment. The rule lists neutral reasons that do not count as suppression, such as abusive content, another person’s personal information, or a review the seller reasonably believes is fake.

For how to respond to the reviews a practice already has, including the privacy limits on what a reply can say, see our guide to replying to patient reviews. For testimonials used in ads, see patient testimonials and before and after photos.

Review stars in Google search results

Many practice websites add review markup in the hope that gold stars will appear next to the practice in search results. Google’s documentation for review snippet structured data rules out the usual approach. It says that if the entity being reviewed controls the reviews about itself, its pages that use LocalBusiness or any other type of Organization structured data are ineligible for the star review feature, and gives as an example reviews placed on the business’s own website directly in structured data or through an embedded widget showing reviews from a third-party platform.

The same documentation says ratings must be sourced directly from users and that sites should not rely on human editors to create, curate or compile ratings information for local businesses. A practice can still show genuine reviews on its website for patients to read. It should not mark them up in the expectation of search stars, and it should not present an aggregate rating that it selected or compiled itself as if it came from patients.

Government quality ratings, such as the CMS Overall Hospital Quality Star Rating, follow their own method and publication schedule. Our guide to hospital star ratings in ads covers how to quote them accurately.

Awards and ratings in Google Ads

Ad text has its own rules. Google’s Misrepresentation policy says making misleading statements, or obscuring or omitting material information, about your identity, affiliations or qualifications is not allowed. A paid listing presented as an earned award, a ranking whose year or source is left out, or a badge that implies an affiliation with a body that does not exist all fit poorly under that policy, on top of the FTC issues above. If an award is worth mentioning in an ad, name it and give its year on the landing page the ad points to.

A checklist before a badge goes on your website

Illustration: a small dental practice receives an email saying its lead dentist has been named a top provider for the year, with a badge available after a licensing payment. The owner wants to know whether to use it. Working through the list below with whoever runs the website gives a clear answer either way.

1. Find the method. Look for a published description of how winners are chosen. If you cannot find one, or the method is a payment, do not use the badge.
2. Check whether payment affects the result. If selection, placement or ranking depends on paying, treat it as a paid ranking under the Guides’ Example 3.
3. Decide on disclosure. If you pay a fee after a genuine selection, ask counsel whether the connection needs to be disclosed, and if so, put the disclosure next to the badge, not in a footer link.
4. Show the name and the year. Use the awarding body’s real name and the year of the award, and set a date to remove it if it is not renewed.
5. Match the words to the award. Describe what was actually recognized, and keep outcome claims out of the copy around the badge.
6. Audit your ratings. Make sure no review was bought, no staff reviews lack a disclosure, nothing is hidden for being negative, and no review schema is set up on your own reviews for search stars.
7. Check the ads. Make sure the ad text and the landing page say the same thing about the award.

How we handle this

When we build or optimize a practice website, we only place awards the practice can document, with the awarding body and year, and we leave out rankings that depend on payment. We do not add review markup to a practice’s own reviews for search stars, and we do not write reviews or ask staff to. Our healthcare SEO service covers how we handle reviews, listings and on-page content for practices.

For numbers in the copy around a badge, such as success rates or outcome comparisons, see our success rates and outcome claims guide.

Sources

• eCFR: 16 CFR Part 255, Guides Concerning the Use of Endorsements and Testimonials in Advertising (255.0(b), 255.1(a), (b) and (d), 255.4 including Example 3, 255.5(a) and Example 10)
• eCFR: 16 CFR Part 465, Use of Consumer Reviews and Testimonials (465.1(d), 465.4, 465.5, 465.6, 465.7(b))
• FTC: Health Products Compliance Guidance (December 2022), claims based on consumer testimonials or expert endorsements
• Google Search Central: Review snippet structured data (self-serving reviews; ratings sourced from users)
• Google Ads policy: Misrepresentation

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