Why Review Gating Often Happens Unintentionally
Many healthcare providers do not intentionally set out to manipulate online reviews. In practice, review gating often emerges from well-meaning operational decisions aimed at protecting staff morale, managing complaints, or avoiding public conflict.
Because reviews influence trust, referrals, and admissions, teams may try to control when and how review requests are sent. Over time, these informal controls can create patterns that appear selective or biased, even when there is no intent to mislead.
Understanding how review gating shows up in real healthcare workflows is the first step toward reducing compliance risk.
What Review Gating Looks Like in Healthcare Settings
Discharge-Based Review Requests
One common practice involves asking for reviews only during or immediately after discharge, often when staff believe the patient or family had a positive experience.
When discharge staff decide whether to mention reviews based on tone, feedback, or outcome, review solicitation becomes inconsistent. Over time, this can result in public reviews that disproportionately reflect positive experiences while negative experiences remain underrepresented.
Even when informal, this approach can be interpreted as selective solicitation.
Screening Surveys Before Sending Review Links
Some organizations use internal surveys to assess satisfaction before deciding whether to send a public review request.
If only respondents who provide positive survey responses are directed to public review platforms, while negative responses are routed elsewhere, this creates a clear form of review gating. Regulators and platforms have identified this pattern as a method of suppressing negative feedback.
The risk increases when this screening process is automated or applied consistently.
“Happy Family” Outreach
Another common example involves follow-up outreach to families perceived as appreciative or satisfied.
Staff may reach out selectively to families who expressed gratitude, left thank-you notes, or had positive interactions, while avoiding families who raised concerns or complaints. Although this may feel reasonable from a customer service perspective, it can result in a skewed review profile that does not reflect the full range of experiences.
Patterns of selective outreach are often easier to detect than individual instances.
Employee or Insider Reviews Used to Offset Negatives
In some cases, healthcare organizations experience negative reviews and respond by encouraging staff, contractors, or individuals with a connection to the organization to leave positive reviews.
When these relationships are not clearly disclosed, insider reviews can raise serious compliance concerns. Even when disclosed, a sudden increase in staff-written reviews following negative feedback can appear coordinated or manipulative.
This practice is frequently cited in enforcement actions and platform removals.
Review “Balancing” Behavior
Review balancing occurs when organizations attempt to offset negative reviews by generating additional positive reviews quickly.
This may include:
- asking staff to “help improve the rating”
- increasing outreach only after negative reviews appear
- focusing review requests during short time windows
Clusters of positive reviews following negative feedback can create patterns that suggest artificial manipulation, even when individual reviews are genuine.
Why These Patterns Raise Red Flags
Regulators and review platforms do not assess review practices in isolation. Instead, they look for patterns over time.
Red flags often include:
- selective timing of review requests
- one-sided sentiment trends
- clusters of reviews from similar sources
- inconsistent solicitation practices across locations
In healthcare, these patterns may be reported by patients, family members, employees, competitors, or members of the public.
How Review Gating Is Detected
Detection does not require internal documentation or admissions. In many cases, review gating is identified through:
- review timing and frequency patterns
- reviewer language similarities
- insider disclosures in review text
- complaints submitted to platforms or regulators
Once concerns are raised, organizations may be asked to explain how reviews are generated and whether solicitation practices are consistent.
How Healthcare Providers Can Reduce Review Gating Risk
Reducing risk requires moving away from discretionary, staff-driven decisions and toward consistent processes.
Helpful principles include:
- offering all patients or families the same opportunity to provide feedback
- avoiding satisfaction-based screening before public review requests
- clearly disclosing relationships when employees or insiders leave reviews
- documenting review outreach practices
- focusing on transparency rather than outcomes
Consistency and fairness matter more than review volume or ratings.
Related Guidance
For a broader overview of regulatory expectations, see our guide to Reputation Risk & Enforcement in Healthcare.
Key Takeaways
- Review gating often emerges unintentionally through operational workflows
- Selective solicitation creates misleading public review profiles
- Regulators and platforms focus on patterns, not intent
- Consistent, unbiased outreach reduces compliance exposure
- Long-term trust matters more than short-term ratings