Washington State Medical Commission advertising rules — a working guide

WAC 246-919-620 — false, fraudulent, deceptive or misleading advertising

WAC 246-919-620 is Washington's purpose-built physician advertising rule. It prohibits advertising that is false, fraudulent, deceptive, or misleading — and lists a series of specific practices that fall into those categories. The rule is a first-read document for any marketing team joining a Washington practice.

• Claims that cannot be substantiated on request. If the Commission asks for the evidence behind a claim, the practice must be able to produce it on the day.
• Misleading comparative statements. Superlatives, "leading" language and rankings without a stated, checkable metric are exposed.
• Guarantees of specific outcomes. Promising a specific result is prohibited; describing typical ranges with material factors is permitted.
• Testimonials that create unjustified expectations. The typicality qualifier must sit inside the advertisement with the same visual weight as the claim.
• Misrepresentation of credentials or specialty. Overstating training, certification or scope of practice is treated as deceptive on its face.
• Non-representative before-and-after photography. Imagery that suggests atypical results without disclosure falls under the deceptive-advertising head.

Testimonials, endorsements and reviews

Washington permits patient testimonials in physician advertising when they are authentic, non-misleading, and unlikely to create unjustified expectations of the results a patient can reasonably achieve. The federal duties layer on. The FTC Endorsement Guides (16 CFR Part 255) require disclosure of any material connection between the endorser and the practice. HIPAA's marketing-authorisation rule (45 CFR 164.508) requires a specific authorisation from the patient for the specific use of their identity, condition or care in marketing.

The working rule for Washington is that a testimonial ad must satisfy four checks. The testimonial reflects the patient's genuine experience. The described result is plausibly typical, or the ad carries a conspicuous "results vary" disclosure with the same visual weight as the claim. Any material connection between the patient and the practice is disclosed in the advertisement itself. A HIPAA authorisation is signed and on file before the ad went live.

Third-party reviews

Review responses are treated as acts of the practice. Confirming a specific patient's presence or care in a public response is a HIPAA disclosure. Soliciting new business on the public review page starts to look like targeted marketing. The safe pattern is neutral, de-identified acknowledgement plus a request to continue offline via patient services. Washington Commission decisions have treated pattern-of-response as evidence of practice-wide policy, so the moderation guideline should be documented.

Imagery and results photography

Before-and-after photography is defensible in Washington when four conditions are met. The images are of actual patients of the practice. The images are unretouched and taken under comparable conditions of lighting, distance and angle. The depicted result is representative of what an ordinary patient can reasonably expect, or the ad carries a conspicuous disclosure that individual results vary. A HIPAA marketing authorisation for the specific use of the imagery is on file, signed by the patient before publication.

Stock imagery is permitted for contextual shots — waiting rooms, exteriors, staff. It becomes deceptive when presented in a way that suggests the practice's own outcomes or the practice's own patients. Where stock is used with a specific-procedure page, a legible "illustrative only" note is the working control.

Short-form video

Short-form video needs its disclosures delivered in a form a reasonable viewer can actually receive at native playback speed. Voice-over disclosures are stronger evidence of delivery than on-screen-only. In Washington, where the WAC 246-919-620 standard is functional (does the ad mislead the ordinary reader?), a disclosure that a reasonable viewer cannot read at speed is a disclosure that has not been given.

A working Washington review playbook

The Washington rule set is functional rather than prescriptive — WAC 246-919-620 asks whether the advertisement is misleading in effect, not whether it ticks a specific box. That functional standard rewards a documented review process. The Commission's investigators respond well to a practice that can walk through its review before an issue arises; they escalate a practice that cannot.

• Pre-brief. Every campaign brief carries a claim list — every specific claim the campaign makes, in plain language, before creative is written.
• Substantiation pass. Every claim has an evidence source recorded in the brief: an internal outcome record, a study, a certification document, a review-count screenshot with the date. Unsubstantiated claims are cut, not softened.
• WAC 246-919-620 checklist. Copy is read against the specific WAC prohibitions — false, fraudulent, deceptive, misleading, unsubstantiated, unsupportable comparative, guaranteed outcome, non-representative imagery, misleading testimonial.
• HIPAA gate. No PHI-tracking pixels on condition or symptom pages. HIPAA authorisations on file for every testimonial and every patient image, dated before publication.
• FTC endorsement check. Every endorsement carries its material-connection line inside the ad, not on a separate disclosures page.
• Advertising evidence pack. A one-page summary per campaign — claims, substantiation sources with document links, reviewers, review dates, HIPAA references, disclaimer versions. Retained centrally.

The Commission handles a large volume of complaints and its investigators prioritise cases where the evidence of harm is clear. A well-run practice with a documented review process rarely becomes the priority case, even when a complaint is filed. The playbook is not just about compliance — it is about staying in the Commission's low-priority queue.