Understanding HIPAA compliance in online review responses

"Understanding the boundaries HIPAA sets is crucial when responding to online reviews. Even a well-meaning reply can inadvertently violate patient privacy, leading to legal trouble and reputational damage," says the Dental and Medical Counsel in an article titled: How to Respond to Online Patient Reviews Without Violating HIPAA.

In the same article, attorney Ali Oromchian, Esq. explains, "Many people associate HIPAA with the obvious—never sharing a patient's medical information. But the law extends beyond that. HIPAA prohibits dental practices from even acknowledging someone is a patient, regardless of what they might disclose themselves." This misunderstanding about HIPAA's scope often leads to well-intentioned but legally problematic responses to online reviews.

A single inappropriate response to a negative review can result in hefty fines, legal action, and irreparable damage to a practice's reputation. As Oromchian warns, "Violating these rules can lead to steep fines, lawsuits, and damage to your practice's reputation.".

Digital reputation in healthcare

Research published in the article Patients trust online reviews, but they don’t leave them, reveals that 84% of patients check online reviews before selecting a new provider, with more than half (51%) reading at least six reviews before making a decision. Even more telling, 61% of patients now prioritize online reviews over personal referrals from friends and family members, representing a shift in how patients approach healthcare decisions.

The impact of online reviews extends beyond initial provider selection. The study found that 40% of patients have changed their care plans—either canceling an appointment or choosing not to book with a particular provider—based on negative online feedback. With 26% of patients considering switching their healthcare providers in 2025, maintaining a strong online reputation has become important for practice sustainability.

However, the healthcare industry faces challenges when it comes to online reputation management. Unlike restaurants or retail stores, healthcare providers cannot simply address complaints by discussing specific service details or customer experiences. Every interaction with a patient is protected by federal privacy laws, creating a delicate balance between reputation management and legal compliance.

Adding to this challenge is the review participation gap: while 84% of patients rely on reviews to make decisions, 57% of patients rarely or never leave reviews for their own providers. This creates a situation where dissatisfied patients are more likely to post reviews than satisfied ones.

As noted in Ethical considerations in responding to negative online reviews, published in the Journal of the American Academy of Dermatology, "Online reviews may increase healthcare system transparency. Access to online reviews, both positive and negative, may foster greater trust in the healthcare system and in specific physicians, ultimately allowing patients to feel more confident in their healthcare decisions."

Understanding HIPAA's scope in digital communications

The Health Insurance Portability and Accountability Act (HIPAA) doesn't just apply to medical records and face-to-face interactions. It extends to all forms of communication, including social media, review platforms, and any public digital space where patient information might be disclosed. As Gayland O. Hethcoat II explains in Disclosing Patient Information in Responses to Online Reviews: Recent OCR Enforcement Action Is a Cautionary Tale, HIPAA "prohibits 'covered entities' from disclosing an individual's PHI, unless the disclosure is required or permitted by HIPAA or the individual has authorized the disclosure."

This broad scope means that even seemingly innocent responses to online reviews can constitute violations if they reveal any protected health information.

Protected Health Information (PHI) under HIPAA includes any information that could identify a patient and relates to their health condition, treatment, or payment for healthcare services. This definition is intentionally broad to ensure patient privacy protection. Importantly, as Oromchian notes, "Even if a patient voluntarily shares protected health information (PHI), such as their diagnosis, treatment, or outcomes, this does not waive their right to privacy. The responsibility to maintain confidentiality always rests with the practice—not the patient."

Principles of HIPAA compliant review responses

Protect patient confidentiality

According to the American Med Spa Association, a healthcare organization should never disclose any protected health information (PHI) in public review responses. This includes:

• Patient names
• Specific medical conditions
• Treatment details
• Dates of service
• Any identifiable personal information

Even if a patient has already revealed this information in their review, healthcare providers cannot acknowledge, confirm, or discuss it publicly. This principle forms the foundation of all HIPAA-compliant review responses.

Craft generic, professional responses

HIPAA-compliant responses lie in their generic nature. Effective responses should:

• Acknowledge the patient's experience without confirming their identity
• Express commitment to quality care
• Offer to discuss concerns privately
• Avoid specifics about individual treatment
• Maintain a professional and empathetic tone

As emphasized in Ethical considerations in responding to negative online reviews, healthcare providers must "ensure that you avoid any identifying language in your response, and use a professional, respectful, non-defensive and apologetic tone."

The patient-provider relationship confirmation 

One of the most common HIPAA violations occurs when providers inadvertently confirm that a reviewer was indeed their patient. An article published in the Journal of Oral and Maxillofacial Surgery states: "The Health Insurance Portability and Accountability Act (HIPAA) governs the privacy and security of patients' protected health information. Providers cannot comment on any patient-specific information publicly, even if the patient has already revealed this information in their online review. Some providers feel compelled to rebut criticism by responding directly to a patient's comments, however, even acknowledging that the person is the provider's patient can violate HIPAA and be subject to legal repercussions."

This point is reinforced both in Ethical considerations in responding to negative online reviews, which states: "Even though the reviewer has self-identified as your patient, a response confirming them as your patient is a potential Health Insurance Portability and Accountability Act violation and could represent a breach of a physician core duty," and by Hethcoat's analysis, noting that OCR has cautioned covered entities that they "may not confirm or deny that a particular person was, in fact, a patient, or disclose any other individually identifiable health information (IIHI) including but not limited to demographic information such as name or address."

This means that even saying "Thank you for being a patient at our practice" can constitute a HIPAA violation if it confirms a patient-provider relationship that wasn't previously known to be public.

What to avoid in review responses

Understanding what not to do is just as important as knowing the right approach. Healthcare providers must avoid:

Defending specific medical decisions

Never attempt to justify or explain specific medical decisions in a public forum. This inevitably leads to disclosure of PHI and can create legal vulnerabilities beyond HIPAA violations.

Sharing patient-specific details

Any detail that could identify a patient or their specific health situation is off-limits. This includes appointment dates, symptoms discussed, treatments provided, or even the department they visited.

Arguing with the review content

Engaging in arguments or attempting to dispute specific claims made in reviews often leads to inadvertent disclosure of protected information. Instead, focus on your general commitment to quality care.

Revealing internal medical discussions

Details about staff meetings, clinical decisions, or internal processes related to patient care should never be shared publicly, even if they might help explain a situation.

Legal and ethical considerations

Understanding the consequences

Improper review responses can trigger consequences for healthcare organizations, including HIPAA violation penalties, patient privacy lawsuits, reputational damage, and increased regulatory scrutiny.

The Office for Civil Rights (OCR) takes online HIPAA violations seriously, with penalties ranging from $137 to $2,067,813 per violation, depending on the severity and whether the violation was willful. Beyond financial penalties, violations can result in corrective action plans, ongoing monitoring, and significant reputational damage.

Ethical obligations beyond legal compliance

Healthcare providers must also consider their ethical obligations when responding to reviews. As highlighted in Ethical considerations in responding to negative online reviews, "As a physician, you have a duty to place the patient-physician relationship and patient's welfare (beneficence) above your own self-interests, including your practice's finances."

This ethical framework reminds providers that responding to reviews should not be solely about reputation management, but about maintaining the trust and integrity that are fundamental to healthcare relationships.

FAQs

Can a healthcare provider ever respond in detail if the review is false or damaging?

No, even if a review is false, providers must avoid specifics and cannot confirm the reviewer is a patient.

What alternatives do providers have for addressing negative reviews?

Providers can use private communication channels or encourage general feedback collection strategies.

Are review platforms themselves responsible for HIPAA compliance?

No, the responsibility lies solely with the healthcare provider, not the platform hosting the review.

Can third-party reputation management services respond on a provider’s behalf?

Only if they are HIPAA compliant business associates with proper agreements in place.

Does HIPAA apply to non-medical staff responding to reviews?

Yes, all staff representing the practice are bound by HIPAA regulations.