By Alicia Gallegos

A Seattle plastic surgeon who illegally restricted patients from posting negative reviews about his practice and directed his staff to post fake positive reviews will pay $5 million for violating Washington state's consumer protection law.

According to a July 1 consent decree, Javad Sajan, MD, and his practice Allure Esthetic must pay $1.5 million in restitution to 21,000 patients and $3.5 million to the state for manipulation of patient ratings.

The settlement resolves a federal lawsuit brought by Washington State Attorney General Bob Ferguson that accused the doctor of illegally suppressing patients' negative reviews by "forcing" them to sign nondisclosure agreements (NDAs) before they received care. In an April decision, US District Judge Ricardo S. Martinez sided with the state, ruling that Allure Esthetic's actions violated the federal Consumer Review Fairness Act (CRFA).

"Writing a truthful review about a business should not subject you to threats or intimidation," Ferguson said in a July 2 statement. "Consumers rely on reviews when determining who to trust, especially services that affect their health and safety. This resolution holds Allure accountable for brazenly violating that trust — and the law — and ensures the clinic stops its harmful conduct."

In court documents, Sajan's attorneys had argued that the agreements did not violate CRFA because patients had the opportunity to modify the language or decline signing them.

The surgeon's practice is "pleased to have resolved its case with the Attorney General's Office," according to a statement provided by Sajan's attorney. "The cooperative settlement, while not admitting fault and resolving claims asserted by both sides, allows Allure Esthetic to continue to focus on its core mission of providing compassionate care to patients and serving the community. The decision to settle was not an easy one, but it was necessary to allocate time and resources where they matter most — the patients."

The dispute stemmed from NDAs that Sajan's practice required patients to sign starting in 2017, according to Ferguson's complaint. The terms instructed patients to contact the business directly if they had concerns rather than post a negative review.

If patients posted negative reviews, the clinic, in some cases, threatened litigation, according to the lawsuit. In other cases, patients were allegedly offered money and free services in exchange for taking the reviews down. Patients who accepted cash or services were required to sign a second agreement forbidding them from posting future negative reviews and imposing a $250,000 penalty for failure to comply, according to court documents.

In addition, Ferguson accused Sajan of creating fake positive accounts of patient experiences and buying fake followers on social media. State investigators found Sajan directed Allure Esthetic's employees to create fake Gmail accounts to post the false reviews, many of which are still online today, according to the state's complaint.

Ferguson also claimed Sajan and his practice manipulated social media to appear more popular by purchasing followers through an online vendor. The practice also allegedly used a social media bot tool to buy thousands of fake likes on Instagram, YouTube, and other social media.

After filing the lawsuit, Ferguson's office uncovered further evidence of Sajan's efforts to influence his professional reputation through fabrication, according to the July 2 release. Allure Esthetic "rigged" "best doctor" competitions hosted by local media outlets by paying staff and contractors to vote for Sajan as "best plastic surgeon" in the region, according to the release. The staff cast as many votes as websites allowed, despite not being patients of Allure Esthetic.

The practice also allegedly edited before and after photos of patients to make their results appear better and kept tens of thousands of dollars in rebates intended for its patients.

In addition to paying $5 million, the consent decree requires Sajan and his practice also:

-Stop posting or influencing consumer reviews; perform a full audit of all public reviews on Google, Yelp, and other third-party review platforms; and request removal of every review Allure Esthetic was involved in creating, posting, or shaping in any manner.

-Remove all misleading "before and after" photographs of plastic surgery procedures from its website and social media and stop altering photographs of future procedures.

-Cease use of and attempts to enforce all illegal NDAs and notify patients who previously signed them that they are released from the terms of those NDAs.

-Pay a third-party forensic accounting firm to perform a full, independent audit of Allure Esthetic's consumer rebate program to identify consumers who are owed rebates that were unlawfully claimed by Allure Esthetic.

Additionally, the attorney general's office will continue to monitor Allure Esthetic, and upon request, the practice must provide information that demonstrates its compliance with the consent decree for the next 10 years.

The practice must also develop internal policies and implement a training program to educate staff about nondeceptive advertising and compliance with consumer protection laws.

Sajan and his practice agreed to the terms of the consent decree, and the settlement is not considered an admission of liability.

Alicia Gallegos is a freelance health care reporter based in the Midwest.