After Dr. Mark J. Mohrmann completed a successful orthopedic procedure in 2019, his patient turned to Yelp, the review website, to share his appreciation.

“Dr. Mark made me feel that I was in safe hands,” the patient wrote in a five-star review.

Only the writer was not an actual patient, and there was no procedure. His review was fake — part of an effort to boost the online ratings for Dr. Mohrmann’s business using phony positive reviews, according to an analysis by Fake Review Watch, an industry watchdog. Last month, Dr. Mohrmann agreed to pay a $100,000 penalty to settle with New York’s attorney general on charges of deceiving the public with fake reviews.

The fake review for Dr. Mohrmann is just one example of the billion-dollar fake review industry, where people and businesses pay marketers to post fake positive reviews to Google Maps, Amazon, Yelp and other platforms, and deceive millions of customers each year.

Fake reviews are as old as the internet itself, and they are illegal and banned by online platforms. But fake review businesses have continued to blossom anyway.

Now, for the first time, a wave of regulation and moves by tech companies are coalescing in a more concerted effort to turn the tide.

This summer, the Federal Trade Commission proposed a sweeping rule that would punish businesses for buying or selling fake reviews, among other restrictions. In October, several online platforms, including Amazon and Expedia, announced a coalition that would share information and resources among companies to combat review fraud. And late last month, New York’s attorney general, Letitia James, issued her own warning across the state, saying in a statement that fake reviews were “illegal and unacceptable.”

Experts warned, however, that the fake review problem may be so enormous that it is insurmountable, and note that fake reviewers survived previous crackdowns.

Jason Brown, the founder of Review Fraud, a consumer advocacy website that has exposed businesses using fake reviews, said platforms had not done enough to manage the problem, but he acknowledged that concern from regulators and companies was swelling.

“Everyone is feeling the heat and pressure,” he said. “Time will tell.”

Almost all fake reviews are positive endorsements, like four-star and five-star reviews, that the businesses write themselves or are created by digital marketers, whose services can be purchased online for as little as a few dollars per review. Many deceptive marketers are based overseas, limiting the F.T.C.’s power to police the problem. And artificial intelligence tools, like ChatGPT, threaten to supercharge the industry by making the fake reviews easier to write, the agency warned.

Fake reviews are so pervasive that nearly every online shopper has most likely encountered one. Amazon said it had blocked more than 200 million suspected fake reviews last year, and Google said it had removed 115 million rule-breaking reviews from Maps in 2022 — an increase of 20 percent from the previous year.

In its proposed rule, the F.T.C. stopped short of issuing new rules against tech giants, pointing to a federal law that shields companies from liability over content posted on their platforms. The agency instead focused on investigating and punishing businesses that buy or sell online reviews, in some cases issuing fines of $50,000 or more.

“The rule will not apply to the architects of the whole corrupt system: the review platforms and tech companies who profit from online reviews whether real or fake,” said Kay Dean, a former federal criminal investigator who runs Fake Review Watch.

Ms. Dean began her effort after online fake reviews misled her to a psychiatric practice. On her YouTube channel, she studiously documents hundreds of businesses that use fake or suspicious reviews, from moving companies to doctors’ offices.

Her investigations often rely on identifying reviewers who rate unconnected businesses around the country — a sure sign of fraud. She found that 19 of Dr. Mohrmann’s supposed patients had also left glowing reviews on Google Maps for the same moving company in Las Vegas, and another 18 apparently used the same locksmith in Texas.

In an emailed statement relayed through his lawyer, Dr. Mohrmann said that “health care professionals focus on patient care and are sometimes not aware of what actions are taken by firms hired to manage online reputation or search engine optimization.” The New York attorney general’s office said that Dr. Mohrmann had “asked friends, family and employees to leave positive, five-star reviews” and that his wife had written some of the reviews.

Review watchdogs like Ms. Dean blamed Google and other large platforms for the problem’s resilience. Those websites tend to rely on customers to self-police fake reviews and usually do not disclose when a business has engaged in suspicious behavior, allowing fraudsters to continue posting fraudulent reviews after old ones are removed.

The Transparency Company, an industry watchdog that develops software to analyze and detect fake reviews, has identified over 100,000 businesses using phony and suspicious reviews to boost their digital image — often in ways that are invisible to an unsuspecting customer.

“One of the reasons I chose to detect fake Google reviews versus Amazon and others is because of the harm done to consumers,” said Curtis Boyd, the founder of the Transparency Company. “A bad $10 kitchen knife, or cheap Bluetooth headset, isn’t going to ruin a household. Choosing the wrong doctor, lawyer or contractor can ruin your life.”

An analysis by the Transparency Company found that half the reviews on Dr. Mohrmann’s Google Maps profile are “highly suspicious,” with many accounts connected to India, Vietnam and Britain. Dr. Mohrmann retains a rating of 4.5 on Google Maps, compared with just 2.5 stars on Yelp. (The latest Google review identified as suspicious was published one year ago.)

Dr. Mohrmann’s lawyer said they were “working closely with the New York attorney general’s office and others to eliminate inauthentic reviews.”

Google Maps has emerged as one of the largest review platforms globally. The company filed its own lawsuit in June against someone else who posted more than 14,000 fake reviews, according to court records.

“When we find bad actors trying to mislead people, we take swift action ranging from content removal to account suspension and even litigation,” Ian Leader, a director of product management at Google Maps, said in an emailed statement.

Amazon appeared to anticipate the F.T.C.’s new regulations in June, announcing a blueprint to stop fake reviews. In a blog post, the company acknowledged that “an illicit ‘fake review broker’ industry has emerged,” vowing crackdowns. The company added more funding to investigate fake review schemes and said it would swap information with rival companies.

By October, Amazon had joined with other large review portals like Expedia to forge the Coalition for Trusted Reviews, a collaboration intended to create shared standards for policing reviews and allowing companies to swap notes on how fraudulent actors operate. But the coalition has not yet described how it would accomplish these goals or how much time and money it would take.

“It would take hundreds of hours from product teams on all the big brands, and a lot of resources,” Mr. Boyd said. “That’s why I’m skeptical.”

Amazon also shifted blame to regulators, writing that the problem “requires government bodies that have the appropriate enforcement authority and funding to pursue these fake review brokers.”

In a statement, a spokeswoman for Amazon said that even as the company fought against fake reviews, the “tactics of fake review brokers have also evolved” to evade detection, but that the company would “suspend, ban and take legal action” against those who violated its policies.

Experts who study the fake review business said industry coalitions were often an attempt to avoid more stringent regulations from lawmakers. The European Union has moved more quickly to hold companies accountable for content posted on their platforms, passing last year the Digital Services Act, which can hold companies legally responsible for fraudulent content.

“Could this be an amazing coalition that has a real impact on the market? Yes,” Mr. Boyd said. “Could it be lip service for ‘how great we all are’? Yes, it could be. It normally is.”

Stuart A. Thompson

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