Fighting back against deceptive forces within the addiction treatment industry that are attempting to profit off of her company’s name is a routine part of the job for Hollie Higgins, business development director for Santé Center for Healing in Argyle, Texas.
In the span of just a few hours on Feb. 22, Higgins says she filed a trademark complaint with Google over another company’s unauthorized use of Santé’s name in a paid search result, sent a cease-and-desist letter to a website offering reviews of treatment centers but listing misleading contact information that directed viewers to an unaffiliated call center, and dealt with another site with a directory of providers that required the companies listed to pay a fee to have their correct contact information included.
The cat-and-mouse game in deceptive online marketing continues. In at least one area, however, a stringent set of regulations was put into place last year: In July, LegitScript, a privately managed verification and monitoring service, unveiled a certification for drug and alcohol addiction treatment providers. Search giant Google adopted the certification as a requirement for advertising in paid search results, social media titan Facebook shortly followed, and Microsoft-backed search engine Bing signed on in March.
The process for treatment centers to obtain certification is extensive, and significant costs are also involved. Still, as evidenced by Higgins’ experience in February, the flow of bad ads has not stopped. Such episodes have left addiction treatment centers to wonder: If LegitScript’s online marketing certification process was designed to shut down deceptive online ads for addiction treatment, is the process actually working?
“It’s a good question,” Marvin Ventrell, executive director of the National Association of Addiction Treatment Providers (NAATP) told BHE in an email. NAATP worked with LegitScript to create the 15 certification standards that determine which organizations qualify.
“We believe the [LegitScript] program is effective, but there are still problematic practices online,” Ventrell continued. “Some of these are not within the control or even purpose of the [LegitScript] program; they are Google issues and some of those issues may simply not be fully controllable. So, one piece of this is that we have to be realistic.”
This is not LegitScript’s first foray into certifications designed to curb dubious online ads in the healthcare sector. In 2010, Google implemented a crackdown on Internet pharmacies’ use of its AdWords platform similar to the one enacted last year for addiction treatment centers. Google worked with the National Association of Boards of Pharmacy to establish an accreditation process, and LegitScript helped to implement the policy by monitoring sponsored search results for prescription drugs and online pharmacies appearing on Google.
Today, the process for drug and alcohol addiction treatment providers to obtain certification is lengthy and highly detailed. Higgins says Santé first was asked to provide basic information, such as the company’s geographic footprint, length of time in business, accreditation letters, audit history, insurance information and patient manuals. That was followed by a request for more than two dozen policies around discharge, intake, medical observation, types of medications used in detox, safety policies, drug screening policies, regulations around visitation and email with internal and external sources, lease agreement and/or land ownership, Santé’s code of ethics, and quality management programs.
To maintain its compliance, Higgins says Santé recently was asked to provide resumes for every principal, executive and licensed clinician on campus, as well as a roster with the name and title of every employee, including kitchen staff, maintenance workers and housekeepers.
Higgins tells Behavioral Healthcare Executive she has no problem providing the amount of information required by LegitScript, but she laments the investment of the Santé’s resources when the company is still seeing the same pre-LegitScript certification era problems arise, as the company has continued to file trademark infringement complaints with Google over paid search result ads.
“Yes, there is the investment on the treatment center side,” she says. “If it was for a mechanism achieving what we hoped it would do, then it’s all worth it. Families and individuals are getting connected to the care they need. But that has not totally been our experience.”
Cleaning up search results through these accreditation processes can take time, but in the case of the crackdown on online pharmacies, the eventual payoff was substantial, David Khalaf, communications specialist for LegitScript, said in an email.
“When we started working with the search engines to clean up the ad space for online pharmacies and other healthcare content in 2010, it took several months, but we've ultimately achieved a sustained reduction with the ratio of bad-to-good ads being a hair above zero (about 0.18%),” Khalaf said. “That continues to this day, and those few that try to slip through are quickly detected and removed.”
Since implementing the certification process for addiction treatment providers, Khalaf said LegitScript has observed a “dramatic decrease in violative ads,” although it’s difficult to pinpoint an exact drop in the number of bad listings appearing now compared to before. The online pharmacy issue had been simmering long before LegitScript got involved, which created a greater body of data to assess, whereas the certification process for addiction treatment providers was launched much more quickly once it became clear a problem existed, Khalaf said.
LegitScript expects a “reduction will continue over time toward a permanent, sustained environment that keeps the bad actors out,” Khalaf said. In the meantime, he empathizes with providers who have completed the certification process and are frustrated to still see bad actors popping up in paid search results. He encourages good-faith operators to report problematic ads when they spot them. Bad ads can be reported either to the platform on which they appear, such as Google, or through LegitScript’s reporting function.
“Reporting is not only useful in removing the problematic ad in question, but in fine-tuning strategies to ensure ads like it don't reappear in the future,” he said.
Exploiting other loopholes
Peter Thomas, NAATP quality assurance officer, said in an email that as certain known problematic behaviors have been addressed, loopholes—including those that don’t fall under the purview of LegitScript—are starting to be exploited elsewhere. These include uncertified call aggregation, and directory and lead sales sites bidding on the names of treatment centers and other specific search terms.
“A common misperception within the field is that Google banned all treatment-related advertising,” Thomas said. “The ban has really been a restriction on specific addiction-related keywords. Websites that are precluded from certification continue to exploit this loophole and find new ways to advertise.”
NAATP has heard “significant frustration from advertisers and members who feel their brands are being unfairly targeted” by these practices, Thomas said, adding that the association has been in touch with advertising platforms to alert them of deceptive listings and that it has worked to educate members on how to mitigate this practice in their campaigns.
NAATP has also been working to close loopholes in its own code of ethics. In March, it announced the release of Ethics Code 2.5, an amendment to address certain provider practices not expressly addressed in version 2.0. Among the changes to NAATP’s code of ethics:
- Member organizations may no longer own, operate or otherwise control directory-style websites. “NAATP believes that it is a fundamental conflict of interest for a treatment provider to operate a directory purporting to unbiasedly direct consumers to care providers,” the association said in a news release announcing the new code.
- Branding requirements for advertising have been clarified, including TV ads that do not identify the provider paying for the ad.
- Ads referring to competitors while promoting one’s own program are prohibited, as are ads for services that the provider does not actually offer.
Meanwhile, Higgins says she will continue her fight against bad actors to protect the integrity of her 23-year-old organization’s brand, and that she hopes regulators such as LegitScript keep going in their efforts as well.
“I hope LegitScript continues to evolve in a way that increases its effectiveness so that families and individuals in crisis who need expert levels of care will get that care,” she says. “It feels vulnerable to talk about. But there is a commitment to the work we do and the people we serve.”