Legal Risks of Paying Rewards to Reviewers on Cosmetic Surgery Review Sites

On beauty and cosmetic surgery review sites, reviews are posted by patients.
There may be instances where the site pays a reward to the patients for such reviews they have provided.

Is it legal for review sites to pay rewards to contributors in order to gather reviews? We will explain the issues and points to be aware of regarding this practice.

Issues with Paying Rewards

When a cosmetic surgery review site pays rewards for patient reviews, it is necessary to comply with the rules of the ‘Japanese Medical Care Payment Regulations’. These regulations are primarily intended for medical institutions that provide insured medical care. However, as a review site that introduces medical institutions, it is also necessary to comply with these rules.

“Prohibition of Referral Fees”

Article 2-4-2 of the ‘Japanese Medical Care Payment Regulations’ prohibits medical institutions from enticing patients by offering economic benefits such as discounts.

Medical institutions must not entice patients to receive medical treatment at their own institution by providing economic benefits that could undermine the sound operation of health insurance business, such as discounting the amount of consideration for goods related to the profit-making business performed by the medical institution in accordance with the amount of expenses received under Article 5.

https://elaws.e-gov.go.jp/search/elawsSearch/elaws_search/lsg0500/detail?lawId=332M50000100015_20190701_501M60000100020&openerCode=1[ja]

In simple terms, the above provision prohibits kickbacks. Therefore, it seems that an agreement between a patient and a medical institution to “reduce costs in exchange for posting a review on a review site” when receiving treatment would be considered a violation of the prohibition.

There have been cases where dental clinics that awarded points instead of cash have had issues with these regulations, so it is necessary to understand that awarding points could also potentially violate the rules.

Note that the above provision is limited to “insured medical institutions”. Some people may think that clinics providing cosmetic surgery services, which are not covered by insurance and are considered free medical care, are not insured medical institutions.

However, it is entirely possible that such medical institutions also provide insured medical care and are designated as insured medical institutions. In cosmetic surgery, although it is generally self-pay medical care, if there is a formal diagnosis under insured medical care and there is a corresponding insured surgical procedure, it falls under the category of insured medical care.

Considering the above, when operating a cosmetic surgery review site, it is advisable to consider the system on the assumption that the listed clinics will be subject to the Medical Care Payment Regulations.

The wording of the above Medical Care Payment Regulations does not specifically list prohibited acts. Therefore, whether an act falls under the prohibition is judged based on the actual situation, and it is necessary to consult with an expert.

Investigation by Administrative Agencies

Health centers and the Ministry of Health, Labor and Welfare check whether there are any problems with the transactions of medical institutions. Therefore, contracts that suggest kickbacks to patients between medical institutions and review sites should not be concluded.

Also, if the review site states on its site that it will pay a reward according to the treatment amount when recruiting patients (contributors), there is a high possibility of being viewed as problematic.

However, it is different if there is no correlation between the reward received from the medical institution and the reward paid for the post by the review site, and there is no correlation between the treatment amount and the reward amount. For example, the act of a review site paying a reward as a consideration for posting a review can be evaluated as a contract that is completed between the review site and the patient.

If you want to introduce a reward system to encourage patient posts, you need to build a system that can be judged as paying a reward for the benefit of the review site, not for the benefit of the medical institution.

For example, if the review site commissions patients to post reviews to enrich the content and increase the number of site views, and pays a reward as a consideration for this, the risk of violating the Medical Care Payment Regulations is reduced.

In any case, it is a difficult case to judge, so we recommend consulting with a lawyer who has extensive expertise.

There is also a point of discussion as to whether it is legally acceptable for a beauty-related review site to receive a reward from a hospital in exchange for posting a review.

For more details on this, please see the article below.

Comparison with Other Medical Websites

In the medical website industry, the following three sites offer rewards to review contributors:

• Beauty Medical Review Square (Japanese: 美容医療のクチコミ広場) (https://clinic.e-kuchikomi.info/[ja])
• caloo (https://caloo.jp/[ja])
• QLIFE (https://www.qlife.jp/[ja])

Regarding the relationship between the sites and medical institutions, both ‘caloo’ and ‘QLIFE’ accept free registration from medical institutions. On the other hand, while ‘Beauty Medical Review Square’ does have an inquiry form, there is no mention of whether there is a registration fee.

As for the rewards, ‘caloo’ and ‘QLIFE’ grant a fixed number of points uniformly for user registration, review posting, and posting of clinic visit information. The rewards are common, making it clear that they are not commensurate with the treatment content.

Handling of Beauty Medical Review Square

‘Beauty Medical Review Square’ appears to determine the number of points based on the content of the treatment reported. Therefore, on this site, the amount of the reward may vary depending on the treatment cost.

However, ‘Beauty Medical Review Square’ has a rule that no reward is given for posts about insurance medical treatment.

Q10. Do I get points for any treatment I receive?
A. You can receive point cash back if you receive a menu listed on the Review Square. *All amounts for insurance medical treatment are not eligible for point cash back.

https://report.clinic/info/faq#open[ja]

As mentioned earlier, the Medical Care Management Rules prohibit insurance medical institutions from adopting a kickback system. Even for patients who have received free medical treatment at an insurance medical institution, referral fees should not be paid. If points are provided to patients who have received free medical treatment according to the treatment cost, there is a possibility of violating the rules.

Taking these circumstances into consideration, in actual operation, it is conceivable that there may be different handling that does not pay rewards for treatments received at insurance medical institutions, not insurance medical treatment.

Ordinary patients usually cannot distinguish between health care institutions and medical institutions that only provide free medical treatment. Considering the lack of patient knowledge, there is a possibility that the disclaimer is limited to insurance medical treatment.

Key Points for Operation

Based on our previous discussions, we recommend that beauty review sites consider paying rewards for reviews only for treatments received at medical institutions that are not health insurance medical institutions. In summary, please pay attention to the following two points when operating.

1. Make the system for patient rewards not correspond to the treatment cost
2. Even if it is a health insurance medical institution, it falls under the Therapeutic Responsibility Rule even for non-insured medical treatments

The act of sending a reward is not prohibited. However, in order not to violate the Therapeutic Responsibility Rule, it is essential to make a system that does not correspond to the treatment cost. Also, please note that if it falls under a health insurance medical institution, even reviews of non-insured treatments are subject to the regulation of the Therapeutic Responsibility Rule.

Not all review content is positive. There may be times when defamatory comments are posted. If you want to delete a post from the “Cosmetic Surgery Review Square”, please refer to this article.

Summary

We have summarized the legal risks associated with cosmetic surgery review sites paying patients for their reviews. The key issue is whether this practice violates the prohibition on referral fees under the Japanese Medical Practitioners’ Act.

The prohibition on referral fees stipulates that “discounts on the price of goods related to the revenue-generating business conducted by the medical institution in question should not be made according to the amount of the fee received.” In other words, adopting a kickback system could potentially lead to a violation of this rule.

The administration checks the transaction details between medical institutions and review sites, so these parties should not include provisions in their contracts that allow for the confirmation of kickbacks to patients.

Another key point is to eliminate the correlation between the treatment received by the patient and the reward they receive. It is risky to adopt a system where the reward from the review site fluctuates depending on the cost of the treatment.

Building an appropriate system can be difficult without legal knowledge, so we recommend consulting with a lawyer. Monolith Law Office has lawyers who are well-versed in internet-related issues, so please feel free to consult with us.