Recently we reported on Medical Justice and its efforts to help its clients squelch negative patient reviews. Now evidence has emerged that MJ has also been posting positive reviews on behalf of its clients on multiple review sites.

Still, there are a lot of unanswered questions. For example, every one of the 86 reviews posted to RateMDs.com gave five stars in every category. Did MJ or its clients filter out more critical reviews?

The first to notice the trend was John Swapceinski of RateMDs.com. Between November 2010 and March 2011, six IP addresses registered to Medical Justice collectively submitted 86 ratings to his site. They reviewed a total of 38 doctors in Florida, New Jersey, California, North Carolina, Hawaii, Texas, Illinois, and seven other states. Several of them appear to be known MJ clients. At our suggestion, Yelp reviewed its logs and found that those same six IP addresses had also been responsible for numerous favorable doctor reviews on Yelp.

Was this sock puppetry? In an interview with Ars, Medical Justice CEO Jeffrey Segal acknowledged that the reviews came from its offices, but insisted that they were "real reviews from real patients" and had not been authored by MJ employees. Segal claims to be working on a system in which "patients are able to input information into a survey in the waiting room." Apparently these reviews are then sent to Medical Justice for posting on various review sites. Segal says Swapceinski simply detected a trial run of this program, which will eventually be available to all patients.

MJ was unwilling or unable to put us in touch with the authors of any of the reviews. When pressed for details about how the system worked, Segal was cagey, refusing to give us a demo or explain how patients interacted with the system. "I'd like to see what you write," he told Ars. "If you write something that's reasonable, we'll give you more details."

Most of Dr. Segal's story checks out. Medical Justice does seem to be developing a program to collect and re-post patient reviews on behalf of its clients. A source tells Ars that Medical Justice is offering its clients what it calls its "Review Builder Program." Draft marketing material obtained by Ars promises to "help you overcome the odd negative review" by submitting reviews to "push down negative links on Internet Searches."

Still, there are a lot of unanswered questions. For example, every one of the 86 reviews posted to RateMDs.com gave five stars in every category. Did MJ or its clients filter out more critical reviews? It's hard to say without more details.

Also, different review sites have different rating scales. Yelp has a single 5-star scale, RateMDs.com solicits ratings for "staff," "punctuality," "helpfulness," and "knowledge," and other sites have still other scales. Does MJ ask patients to choose ratings for all of these categories? Or does it "help" users out by filling in those fields itself? Unfortunately, MJ wouldn't talk to us about it.

Swapceinski told Ars that MJ created the accounts with "obviously one-off, throwaway" e-mail addresses. He also pointed out that identical reviews are being posted on multiple sites under different names. For example, one plastic surgeon has identical glowing reviews on five different sites under the names "Devin C," "Casey962," "Emerson342," and "Skyler L."

"I believe this is fraud," Swapceinski told Ars in an e-mailed statement. "The ratings are written in the first person but the person doing the submitting is not the actual patient, and there is no indication given that a third party is submitting the review on behalf of a patient. Therefore, this is astroturfing, sock puppetry, and fraud."

Yelp spokeswoman Stephanie Ichinose was also critical of Medical Justice's activities. She told Ars that reviews originating from Medical Justice IP addresses had been removed for violating the Yelp terms of service, which state that "you may not impersonate someone else, create or use an account for anyone other than yourself [or] provide an email address other than your own." She also touted Yelp's review filtering system, which she said had automatically detected and blocked many of the Medical Justice submissions before the manual review was conducted.

Impersonating a satisfied customer online is no laughing matter. In 2009, a cosmetic surgery company agreed to pay a $300,000 fine to the state of New York for posting fake, positive reviews of itself online. On the other hand, this is pretty funny. (Update: MJ seems to have removed this post, which was titled "Thou Shall Not Impersonate Others on the Internet," but Google has a copy.)

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