Review gating: the FTC line and the platforms' own bans

What Counts as Review Gating

Review gating means sorting patients before they ever reach a public review site — asking only the ones you expect to praise you, or routing anyone who reports a bad visit to a private feedback form instead of Google or Yelp. The FTC's endorsement guidance treats that selective filtering as a form of manufactured social proof, not a customer-service courtesy 1Ref 1Federal Trade Commission (2023).FTC's Endorsement Guides: What People Are Asking.That soliciting reviews only from patients expected to respond favorably — review gating — violates FTC endorsement policy regardless of intent to deceive..

The test isn't whether a review is ever suppressed — it's whether the decision to ask (or not ask) depends on how the patient is expected to feel. Common patterns and where they land:

None of these require an intent to deceive to violate the rule. The filtering itself is the violation 1Ref 1Federal Trade Commission (2023).FTC's Endorsement Guides: What People Are Asking.That soliciting reviews only from patients expected to respond favorably — review gating — violates FTC endorsement policy regardless of intent to deceive..

The 2024 FTC Rule: What's Now Enforceable

The FTC's 2024 rule turned review gating from guidance into a binding rule that carries civil penalties per violation, so the agency no longer needs to prove intent to deceive case by case 2Ref 2Federal Trade Commission (2024).Federal Trade Commission Announces Final Rule Banning Fake Reviews and Testimonials.The FTC's 2024 rule making review gating, purchased reviews, and review suppression subject to civil penalties, in force as of July 2026.. The rule reaches four practices: paying for positive reviews, reviewing your own business without disclosing the connection, suppressing negative reviews you know are genuine, and — the one that catches gating — soliciting reviews only from people likely to respond favorably 2Ref 2Federal Trade Commission (2024).Federal Trade Commission Announces Final Rule Banning Fake Reviews and Testimonials.The FTC's 2024 rule making review gating, purchased reviews, and review suppression subject to civil penalties, in force as of July 2026..

As of July 2026 the rule is in force, and a solo practice faces the same per-violation exposure as a large health system — the rule doesn't scale penalties to practice size. The four prohibited patterns above are the whole list; anything outside them (a genuinely uniform ask, a genuine reply, a genuine negative review left standing) is not what the rule reaches.

Where HIPAA Layers On Top

If your filter for who gets a review request draws on anything in the clinical record — a good outcome note, a clean no-show history, "this one went well" — you've used protected health information to decide who receives a marketing communication, and HIPAA requires the patient's authorization before you can do that 3Ref 3HHS Office for Civil Rights (2026).Marketing.That selecting review-request recipients using protected health information (e.g., chart-noted outcomes) is a use of PHI for marketing requiring patient authorization.. A front-desk read of the patient's mood in the waiting room doesn't touch PHI; a filter built from chart data does.

The safer design sidesteps this entirely: ask every discharged patient, using nothing from the clinical record to decide who's on the list. That keeps the HIPAA marketing-authorization question from ever arising, because the criterion for asking ("you were seen here") isn't itself PHI-derived selection — it's a fact about scheduling, not treatment content 3Ref 3HHS Office for Civil Rights (2026).Marketing.That selecting review-request recipients using protected health information (e.g., chart-noted outcomes) is a use of PHI for marketing requiring patient authorization..

Texting or Calling to Ask — the Consent Layer

If your review-request goes out as an automated text or a prerecorded call rather than a handout or a live conversation, the TCPA controls how you can send it: prior express consent from that patient, obtained before the message goes out, not implied just because they're on your patient list 4Ref 4Federal Communications Commission (2026).Telemarketing and robocalls.That automated review-request texts or calls require prior express consent under the TCPA before they can be sent to a patient.. A single text sent manually from a staff member's phone sits outside the autodialer rule; a batch send from practice-management software usually doesn't.

Capture consent for review-request texting the same place you capture consent for appointment reminders — at intake, in writing, with an easy opt-out — and keep the record. If a patient never gave that consent, ask by handout, email, or in person instead; those channels don't carry the TCPA's consent requirement the same way 4Ref 4Federal Communications Commission (2026).Telemarketing and robocalls.That automated review-request texts or calls require prior express consent under the TCPA before they can be sent to a patient..

A Compliant Ask-For-Reviews Workflow

The workflow that avoids gating is the one that removes the human decision point: every patient who completes a visit gets the same review-request touch, sent the same way, on the same schedule — never triggered by how the visit went. Build the ask into checkout or discharge paperwork rather than a staff member's judgment call, and you've engineered the rule into the process instead of relying on remembering it.

• Send the same request to every patient, on the same schedule, with no branching before it reaches the public platform.
• If you also want private feedback, run it as a separate loop, clearly labeled as internal — never folded into the public review ask so that unhappy patients get quietly diverted.
• Keep a simple log of who received the request and when, so you can show a uniform process if a platform or the FTC ever asks.
• Never offer anything of value — a discount, a gift card, a raffle entry — for a review; that collides with the fake-review rule's ban on incentivized reviews 2Ref 2Federal Trade Commission (2024).Federal Trade Commission Announces Final Rule Banning Fake Reviews and Testimonials.The FTC's 2024 rule making review gating, purchased reviews, and review suppression subject to civil penalties, in force as of July 2026..

Platform Rules Stack on Top of Federal Law

Google, Yelp, and Healthgrades ban review gating in their own terms of service, independent of the FTC, and enforce it with profile suspension or review removal rather than a fine — a faster, more common consequence for most solo practices than federal action ever is. A profile flagged for filtered solicitation can lose its accumulated review history entirely, which does more damage to local seo standing than a scattering of honest negative reviews ever would.

The companion piece on asking for reviews covers the incentive rules — gift cards, discounts, review-for-a-freebie — that platforms police even more aggressively than the FTC does, and walks through a request process that clears both bars at once. Treat review solicitation as one line item in your marketing plan governed by the same rule as everything else in it: ask honestly, ask everyone, and let the reviews land where they land.