When a negative review becomes defamation, with Michael Pelagalli of Minc Law

In a June survey from reputation management company rater8, 55% of adults said they had walked away from at least one physician because of something they read online.

When one of those reviews is fake or false, Michael Pelagalli, J.D., says HIPAA leaves physicians with very little they can say in a public reply, and federal regulators have fined practices that said too much.

Medical Economics Associate Editor Austin Littrell sat down with Pelagalli, a partner at Minc Law, a Cleveland firm that works exclusively on internet defamation and online reputation matters.

Pelagalli explains the difference between a defamatory review and a protected opinion. He covers what a practice should document and flag the moment a false review appears and how his firm uses John Doe lawsuits and subpoenas to unmask anonymous reviewers.

He also describes a case in which dozens of fake reviews traced back to a family physician in the next county over. And he discusses the RESPOND Act, an advocacy campaign to amend HIPAA so physicians could reply in proportion to what a patient has already disclosed.

Don't miss our recent episodes on patient access to medications, value-based care, prescription abandonment and same-day Medicare payment cuts.

Music Credits:

Groovy 90s Hip Hop Acid Jazz by Musinova - stock.adobe.com

A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:28 | Cold open. Pelagalli on the family physician who woke up to dozens of fake reviews overnight.

0:28 – 1:52 | Introduction. Austin Littrell introduces the episode and the guest.

1:52 – 4:09 | Meet Michael Pelagalli. Pelagalli describes Minc Law's focus on online defamation, harassment and extortion. He explains how his early career defending physicians in malpractice cases led to the health care side of his practice.

4:09 – 6:13 | Opinion vs. fact. A rude physician or a long wait is opinion. Pelagalli explains why a claim that a surgeon was intoxicated in the operating room is a statement of fact that records can disprove.

6:13 – 10:16 | When a review crosses the line. Why reviews from real patients are harder to pursue than reviews from people who never were patients. Pelagalli describes a physician who took a patient's repeated accusations, which investigators had cleared, all the way to trial and won.

10:16 – 14:19 | The first step after a false review appears. Document it, check it against patient records and flag reviews from nonpatients to the platform repeatedly. Pelagalli explains when to call a lawyer before responding at all.

14:19 – 15:12 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

15:12 – 18:21 | How much a physician can say in reply. A generic invitation to talk privately is allowed. Confirming that the reviewer was ever a patient is not, even if the patient already said so.

18:21 – 21:24 | The RESPOND Act. Pelagalli on an advocacy effort to amend HIPAA so physicians could answer in proportion to what a patient has disclosed, and why litigation shouldn't be the only option.

21:24 – 26:43 | Unmasking an anonymous reviewer. How John Doe lawsuits, platform subpoenas, basic subscriber information and IP addresses lead to a name. Pelagalli explains what the letter to the unmasked reviewer says.

26:43 – 29:33 | When the reviewer is a competitor. The family physician from the next county over, and why a competitor opens the door to unfair competition, tortious interference and Lanham Act claims.

29:33 – 31:18 | Act promptly. Pelagalli says reaching the patient privately within a couple of days or a week makes removal far more likely than letting reviews pile up.

31:18 – End | Closing thoughts and outro. Littrell thanks Pelagalli and wraps the episode.