Paid spokespeople and celebrity endorsements in practice ads: the FTC and state rules

A known face can make a practice ad stand out: a local sports figure who had their knee done, a television personality who trusts your med spa, a physician who appears in your radio spot, or an actor in scrubs who explains a procedure. Each of these is a person speaking for your business, and federal law treats what they say as your claim. The FTC Endorsement Guides, revised in 2023, set out when a paid spokesperson becomes an endorser, what that endorser must have actually done and believed, how payment has to be disclosed, and what an ad may imply about results. State licensing rules add their own requirements for testimonials, actors and paid presentations.

This guide is for practice owners, med spa and dental groups, chiropractors and health businesses that hire a spokesperson, a well-known person, a clinician or an actor for TV, radio, print, outdoor or online ads. Paid posts by social media creators are covered in our guide to healthcare influencer marketing. Sponsor identification and spoken disclosures on air are covered in our guide to radio, TV and streaming ads for practices, and generated presenters in our guide to AI voices and avatars in practice ads. When a doctor or other expert endorses a product, see our guide to clinically proven and doctor recommended claims.

The short version

• A known face is an endorser even when reading a script. If viewers are likely to take the words as the person’s own views, the Endorsement Guides apply. A plain announcer speaking for the company is not an endorser.
• The endorser has to mean it, and has to have used it. An ad that says the person had the treatment needs a person who really had it, and the practice may keep running the ad only while it has good reason to believe they still hold those views.
• Disclose the payment where the claim is made. A paid relationship that viewers would not expect has to be disclosed clearly, in the audio if the claim is spoken and on screen if it is shown. Closing credits are not enough.
• A clinician spokesperson is an expert. Their qualifications have to match what the ad implies, and they have to have actually used that expertise to evaluate what they endorse.
• A disclaimer does not fix a results claim. If the endorser’s outcome is not what patients can generally expect, say what patients can generally expect, and have support for that.
• Actors need a label. People presented as patients who are not patients need a clear disclosure. Texas and California have their own rules on models and actors.

When a paid spokesperson is an endorser

16 CFR 255.0(b) defines an endorsement as an advertising message that consumers are likely to believe reflects the opinions, beliefs, findings or experiences of a party other than the sponsoring advertiser. A name, likeness, signature or other identifying personal characteristic can be an endorsement on its own. The test is what the audience is likely to believe, not what the contract calls the person.

The examples in 255.0 draw the line clearly:

• An announcer is not an endorser. In Example 3, an announcer known to consumers only as a company spokesperson praises a pain remedy. The announcer does not claim to speak from personal experience or their own opinions, but on behalf of the company, so the statements are not an endorsement. They are still the company’s own claims and still need support.
• A well-known person is. In Example 4, a well-known racing driver delivers a tire maker’s message. Because consumers recognize the driver as a driver and not merely as a spokesperson, they are likely to believe the message reflects the driver’s views and knowledge, which makes it an endorsement.
• A script does not change that. In Example 6, a well-known actor in an infomercial says a machine is the best one they have ever tried. Even if the actor is reading from a script, that is an endorsement. If the same actor only describes features and price and says nothing that suggests their own view, there is no endorsement.

For a practice, this means a local news anchor, a coach or a former player who says “I trust [Practice name]” is an endorser. A voice actor who reads “[Practice name] offers evening appointments” is not. The practice is responsible for both, but the endorser rules below add duties that apply only to the first.

Celebrities: real use and current views

16 CFR 255.1(a) requires endorsements to reflect the honest opinions, findings, beliefs or experience of the endorser, and bars an endorsement from conveying any claim that would be deceptive if the advertiser made it directly. Three duties follow for a well-known person.

• Real use. Under 255.1(c), when an ad represents that the endorser uses the product or service, the endorser must have been a bona fide user when the endorsement was given. A celebrity who says they had a treatment at your practice has to have had it there.
• Current views. 255.1(b) says an advertiser may use an endorsement of an expert or celebrity only so long as it has good reason to believe the endorser still holds the views presented. The advertiser can meet this by checking the endorser’s views at reasonable intervals, with factors including new information about the service, a material change in it and the advertiser’s contract commitments. 255.1(c) applies the same test to continued use.
• Words in context. 255.1(b) also says an endorsement need not use the endorser’s exact words unless the ad says it does, for example with quotation marks, but it may not be presented out of context or reworded to distort their opinion or experience.

Both sides can be liable. 255.1(d) says advertisers are subject to liability for misleading or unsubstantiated statements made through endorsements, and an advertiser may be liable even when the endorser is not. 255.1(e) says endorsers may be liable for statements they know or should know to be deceptive, including falsely claiming they used a product. In Example 4 of 255.1, a celebrity in an infomercial watches a cooker fail five times, then praises a perfect result taken from a second machine. The FTC says the celebrity is liable because they know the statement is untrue, and the advertiser is also liable. 255.1(f) adds that ad agencies and similar intermediaries may be liable for their roles in endorsements they know or should know are deceptive.

The FTC consumer review rule reaches celebrity testimonials directly. 16 CFR 465.1 defines a celebrity testimonial as a message that consumers are likely to believe reflects the opinions or experiences of a well-known individual who purchased, used or otherwise had experience with the product or business. Under 465.2(b), a business may not disseminate a celebrity testimonial about itself that it knew or should have known materially misrepresented that the person exists, that they had experience with the business, or what that experience was.

Disclosing the payment

16 CFR 255.5(a) requires a connection between the endorser and the seller to be disclosed clearly and conspicuously when it might materially affect the weight or credibility of the endorsement and the audience does not reasonably expect it. Material connections include payment, free or discounted products or services, and business, family or personal relationships. The disclosure does not need the complete details of the deal, but it has to tell consumers the nature of the connection well enough for them to judge it.

Example 3 in 255.5 is a health care case. A well-known tennis player appears on a TV talk show and talks about the laser vision surgery they had at a named clinic, without disclosing a contract that pays them to speak publicly about the surgery. The FTC says consumers might not realize the player was paid, that knowing would likely affect how much weight they give the endorsement, and that without a clear disclosure during the interview that the player is a spokesperson for the clinic, the endorsement is likely deceptive. A disclosure in the closing credits would not be clear and conspicuous. The same example adds that if viewers are likely to take the player’s experience as representative of patients at the clinic, the advertiser needs support for that claim.

When is a payment expected? Example 2 in 255.5 says no disclosure is needed when a film star endorses a food in a TV commercial, because viewers ordinarily expect such payments. A well-known person who appears in your own commercial, with your name and logo on screen, is plainly part of an ad, but the rest of 255.1 still applies. A celebrity who praises you in an interview, on a podcast or at a community event, without saying they are paid, is the case the FTC flags. If in doubt, disclose.

For how to disclose, 255.0(f) says a disclosure has to be difficult to miss and easily understandable. A claim made in sound needs the disclosure at least in the audio, a claim made on screen needs it at least on screen, and a claim made in both needs it in both. Use plain words such as “[Name] is a paid spokesperson for [Practice name].” Our radio and TV guide covers the separate FCC sponsor identification rules for paid segments on air.

Clinicians as paid spokespeople

When an ad presents the speaker as a doctor, dentist, nurse practitioner or other clinician, the expert rules apply. 16 CFR 255.3(a) says that when an ad represents the endorser as an expert, their qualifications must in fact give them the expertise they are represented as having. 255.3(b) says the endorsement must be supported by an actual exercise of that expertise in evaluating the product or service, with an examination at least as thorough as someone with that expertise would normally need to support the conclusions in the ad.

Two examples in 255.3 apply directly to health ads. In Example 2, an endorser of a hearing aid is called a doctor. The ad likely implies expertise in hearing, and a doctor without substantial experience in that area could endorse it only if the ad clearly discloses the nature and limits of their expertise. In Example 6, a medical doctor says a drug will safely lower cholesterol by 50 points. If the doctor relied on letters from satisfied consumers or a rodent study, the endorsement is likely deceptive, and both the advertiser and the doctor would be liable.

For a practice, a paid physician spokesperson from outside the practice should be introduced with their actual specialty and license type, should have reviewed the service or device they speak about with the care their field expects, and should not vouch for outcomes the evidence does not support. Their payment or other connection is a material connection under 255.5. If the clinician posts on their own social accounts, our influencer guide covers that side, and our guide to physician advertising rules covers how to state credentials.

Results claims: why a short disclaimer is not enough

16 CFR 255.2(a) says an ad with consumer endorsements about performance will be read as saying the service is effective for the purpose shown, so the advertiser needs the same support, including competent and reliable scientific evidence where appropriate, as if it made the claim itself. Consumer endorsements are not themselves competent and reliable scientific evidence.

255.2(b) says an endorsement about the experience of one or more consumers on a key attribute will likely be read as showing what consumers will generally achieve. If the advertiser cannot support that, the ad should clearly disclose the generally expected performance in the depicted circumstances, and have support for that figure too. The disclosure must change the net impression so the ad is not misleading.

The examples in 255.2 reject short disclaimers. In one, three customers describe large savings, and the FTC says a line stating that the results are not what buyers will get, or that viewers are not likely to have similar results, is not enough, because viewers will still read the ad as showing what they can expect. A celebrity who lost weight, cleared their skin or returned to sport after treatment is a consumer endorser on that point. If their result is not what your patients generally achieve, the ad needs what patients generally achieve, from your own records or published evidence, and not a disclaimer alone. Our patient testimonials guide covers patient stories in more detail.

Actors playing patients and doctors

16 CFR 255.2(c) says ads presenting endorsements by people represented as actual consumers should use actual consumers in both audio and video, or clearly disclose that the people shown are not actual consumers. An actor playing a patient who describes recovery needs that label, and a label does not make an invented outcome acceptable, because 255.2(a) and (b) still apply to the result shown. 255.1(g) adds that using the image or likeness of a person other than the actual endorser is deceptive if it misrepresents a material attribute of the endorser.

An actor in a white coat raises a second question: whether viewers will take them for a clinician. Under 255.3(a), an ad that implies the speaker is an expert needs a speaker with that expertise. If the actor is presenting information on your behalf and not as a doctor, make that plain on screen and in the script. Our guide to healthcare video marketing covers casting and filming in the office.

Two state examples, for physicians and similar licensees in those states:

• Texas. 22 Texas Administrative Code section 164.3(b), adopted by the Texas Medical Board, lists as false, deceptive or misleading advertising: a testimonial without a disclaimer about the credentials of the person giving it and a disclosure of compensation paid for it (b)(3); failing to explicitly identify individuals as models or actors instead of actual patients (b)(4); and failing to disclose that an advertisement, article or infomercial is a paid presentation (b)(7).
• California. Business and Professions Code section 651(b)(3)(B) says that using a photograph or other image of a model without clearly stating, in a prominent location and easily readable type, that it shows a model is a violation. For this rule, a model is anyone other than an actual patient of the advertising licensee who has had the procedure advertised. Section 651(b)(3)(A) separately covers images that do not accurately depict results or have been altered.

Other states have their own rules for each license type, so check yours.

Famous patients, likeness rights and Google

A well-known person who is also your patient is still a patient. Under the HIPAA Privacy Rule, using a patient’s story, image or voice to promote your services is marketing as defined in 45 CFR 164.501, and 45 CFR 164.508(a)(3) requires the patient’s written authorization before you use their information that way. A talent agreement or production release does not replace the HIPAA authorization. Our guide to patient photo consent covers the form.

A well-known person who is not part of your campaign cannot appear in it. California Civil Code section 3344(a)(1) makes a person who knowingly uses another’s name, voice, signature, photograph or likeness for advertising without prior consent liable for damages. Other states have their own likeness laws, so check yours. That covers a celebrity photo from a red-carpet event, a sound-alike voice built to suggest a known person, and a repost of a celebrity’s public comment about your clinic framed as an ad.

Google’s Misrepresentation policy for ads bars misleading statements or omissions about your identity, affiliations or qualifications, and lists as an example implying affiliation with or endorsement by another organization, brand or private citizen without their knowledge or consent. A search ad, landing page or display ad that suggests a known person endorses your practice needs that person’s real, current consent behind it.

What to put in the spokesperson agreement

255.1(d) says advertisers should give endorsers guidance on avoiding misleading statements and disclosing connections, monitor compliance, and act to remedy problems. A written agreement is where that starts. Have your attorney cover:

• What the person actually did. Whether they had the treatment, where and when, and a statement that the views in the script are their own.
• Script approval. The practice approves each claim before use, and the spokesperson does not add outcome, safety or comparison claims of their own.
• Disclosure wording. The exact words that say they are paid or otherwise connected, where each disclosure goes, and the duty to make it in interviews and on their own channels.
• Credentials. For a clinician, their specialty and license type as they will appear, and what they reviewed before endorsing.
• HIPAA authorization. If they are a patient, a separate written authorization that meets 45 CFR 164.508, apart from the talent contract.
• Check-ins and changes. When the practice will confirm the person still holds the views and still uses the service, as 255.1(b) and (c) contemplate.
• End date and takedown. When the ads stop, who removes them from the website, ad accounts, print runs and social channels, and what happens if the person’s views change or the relationship ends early.

Questions to ask before the ad runs

• Will viewers think this person is speaking from their own experience or opinion, or for the practice?
• Did the person actually have the treatment, here, and do they hold the views in the script today?
• Is the payment or other connection disclosed in the same place, and in the same form, as the claim?
• If the person is presented as a clinician, do their qualifications and their review support each claim?
• Does the ad show a result patients will not generally achieve? If so, what figure do we show, and what supports it?
• Are actors labeled, and does the state rule for our license type say anything more?
• If the person is our patient, do we have a signed HIPAA authorization for this use?

Use and avoid

• Payment. Use: “[Name] is a paid spokesperson for [Practice name].” in the audio and on screen. Avoid: a disclosure only in closing credits or a linked page.
• Real use. Use: “[Name] had [treatment] at [Practice name] in [year].” when that is true. Avoid: “[Name] trusts [Practice name]” from someone who has never been a patient.
• Results. Use: “Patients in our records with [condition] who completed [treatment] reported [outcome] on average.” when you have that data. Avoid: a celebrity’s result with “individual results vary” and nothing more.
• Clinicians. Use: “Dr. [Name], board certified in [specialty], reviewed [device].” when true. Avoid: “Doctor recommended” with no name, specialty or review behind it.
• Actors. Use: “Actor portrayal. Not an actual patient.” on screen whenever the actor is shown as a patient. Avoid: an actor in scrubs with no label.
• Likeness. Use: images of people who signed a consent for this use. Avoid: a celebrity photo, sound-alike voice or reposted comment presented as an endorsement.

An illustration

This example is invented. [Practice name], an orthopedic and sports medicine practice in [Town], wants a TV and radio campaign with a former local athlete, [Name], who had knee surgery there. The first script has [Name] say “I was back on the field in six weeks, and you will be too”, shows the practice logo, and puts “paid endorsement” in the closing credits. A second spot uses an actor in a white coat who says “Doctors agree this is the best knee program in the state.”

The owner reviews both with their attorney. [Name]’s line becomes “I had knee surgery at [Practice name] in [year]. My recovery was my own, and yours will depend on your knee and your surgeon’s plan.” The spot adds “[Name] is a paid spokesperson for [Practice name]” in the voice-over and on screen while [Name] is speaking. The practice confirms in writing that [Name] signed a HIPAA authorization for the campaign, separate from the talent contract, and sets a date each year to confirm [Name] still holds the views in the script. The actor spot is rewritten so the actor reads only facts about the practice, with no “doctors agree” line and no white coat, and a surgeon from the practice records a separate spot describing what the program includes, with their specialty on screen.

Checklist

• Each person in the ad classed as announcer, endorser, expert endorser or actor.
• Proof on file that each endorser had the treatment and holds the views in the script.
• Payment or other material connection disclosed where the claim is made, in audio and on screen as needed.
• Clinician credentials, specialty and the review they did, recorded and shown accurately.
• Results claims supported, with the generally expected outcome shown where needed.
• Actors labeled as actors, and state rules checked for each license type in the practice.
• HIPAA authorization signed by any patient who appears, separate from the talent contract.
• Written consent from each person whose name, voice or likeness appears.
• Google ads and landing pages checked against the Misrepresentation policy.
• Check-in date, end date and takedown owner set in the agreement.

How we help

We build practice websites, local SEO, Google Ads and lead generation and an AI front desk for independent practices. For spokesperson and celebrity campaigns, we draft scripts and landing pages that keep the disclosure next to the claim, label actors, check results language against your records, and review Google Ads for practices against the Misrepresentation policy before launch. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. For the wider rules, see our healthcare marketing rules guide.

Sources

• 16 CFR Part 255: Guides Concerning Use of Endorsements and Testimonials in Advertising
• 88 FR 48092: Guides Concerning the Use of Endorsements and Testimonials in Advertising (July 26, 2023)
• 16 CFR Part 465: Use of Consumer Reviews and Testimonials
• 15 U.S.C. 45: Unfair methods of competition unlawful (FTC Act section 5)
• 45 CFR 164.501: Definitions (marketing)
• 45 CFR 164.508: Uses and disclosures for which an authorization is required
• 22 Texas Administrative Code section 164.3: Prohibited acts or omissions in advertising
• California Business and Professions Code section 651
• California Civil Code section 3344
• Google Advertising Policies Help: Misleading representation

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