Published on Dec 09, 2022
InMode (INMD), a manufacturer of aesthetic medical devices, often does not tell doctors interested in purchasing their products about the additional licensing requirements needed to operate the devices, according to former company sales representatives. The omission, the former employees say, often leaves doctors with an unusable piece of equipment for which they are making high monthly payments.
InMode produces a range of medical devices that use lasers and high-frequency radio waves to contour a patient’s features in an effort to melt fat and reduce wrinkles. The company advertises these devices as minimally-invasive and easy to use, and targets sales towards medical professionals such as dentists interested in creating new streams of revenue for their practices.
“This is the problem with InMode,” a former sales manager told The Capitol Forum, “They get dentists, chiropractors, general practitioners, people who have no business to get into aesthetics and don’t have the patient mix for aesthetics either and tell them this will be a moneymaker with little effort.”
Four former sales representatives of InMode, all of whom requested anonymity to discuss the sales practices, told The Capitol Forum that they knew that they were promoting unrealistic earnings potentials to doctors and omitting information about the legal operation of the devices.
Despite these mischaracterizations and omissions, InMode would sell devices that would cost up to $150,000 to these doctors, and the former sales representatives told The Capitol Forum that the vast majority of sales are financed using high-interest loans.
“The majority of the doctors were already in so much debt due to the health care reimbursements staying the same while overhead costs continued to increase,” another former sales employee said, “Our job was convincing them of the need for our device to create a cash based revenue stream to help offset the impacts of inflation. Most of the time, we were convincing providers to take out 6 figure loans to pay for the device.”
Complaints made to the FTC, as well as legal filings against InMode, corroborate the former employees’ statements, with doctors claiming that InMode representatives deceived them about the requirements to operate the machines and the financing arrangements.
In response to a request for comment, InMode’s lawyers sent The Capitol Forum a statement from the company.
“InMode is the market leader in the production and sale of state-of-the-art aesthetic devices worldwide, and Morhpeus8 [SIC] is the most popular and widely used device of its class. As a company, InMode prioritizes the safety and satisfaction of patients and practices, above all,” the statement reads, “InMode adheres to stringent legal review and gatekeeping functions above and beyond what is required in the marketing and sales of its devices, and well beyond what its competitors are doing in this very competitive marketplace.”
“It is disappointing to see former sales representatives, who are likely no longer with the company for good reason, creating confusion with regard to a sales professional’s responsibility versus the customer’s,” the statement continues, “It should go without saying that it is incumbent on clinicians and other providers of medical services to ensure they are abreast of their own individual licensing and certification requirements in their respective states in advance of purchasing any equipment, and InMode customers must contractually acknowledge this responsibility before purchasing any InMode device.”
Invasive devices. While InMode markets its devices as noninvasive and minimally invasive, several of its popular devices, such as Accutite and Morpheus8, penetrate the skin of patients to deliver heat and radiofrequency waves to improve their appearance.
The Morpheus8, for example, uses a series of up to 40 small needles that penetrate the skin of patients up to 7mm deep and then deliver radiofrequency waves to generate heat under the skin. By damaging the skin in a controlled way, the device is meant to induce the creation of collagen to resurface the skin to remove wrinkles and fat deposits.
While celebrities like Paula Abdul and Kim Kardashian have praised the Morpheus8, consumers have been complaining about damage and burns to their skin resulting from the treatments. In Facebook groups and in lawsuits consumers often provide graphic imagery of the harm the company’s devices can cause.
The Capitol Forum spoke with the director of a med spa in California that was sold a Morpheus8 device. As part of the demonstration for the staff, she was given a free treatment by an InMode employee.
“First day afterwards was fine, but the second day I was really itchy,” the director said, “I followed all the instructions to keep it moisturized, but it kept getting worse. After a week, it was so inflamed and I could see the track marks where it had been. I called InMode and they were very dismissive of me. They didn’t want to blame the machine, so they told me I was having a bad reaction to the numbing creme. I couldn’t sleep, it was awful.”
According to the director, they went to the dermatologist, who told her that they were seeing this issue more and more.
“He told me it was a histamine reaction due to multiple passes on an RF device on my skin and they had been too aggressive,” the director said, “Then he asked, ‘Did you get this done at a med spa?’ And I said yes, and he told me that you should only do this at a doctor’s office, that there should really be an MD overseeing this procedure.”
Doctors misled about state requirements. While that dermatologist recommended only a doctor should oversee a procedure like Morpheus8, one of the main selling points of InMode treatments is that they are easy to do and can be delegated to other employees at an office.
In a video produced by InMode detailing how to perform Morpheus8 and how much a practice can charge for the procedure, the presenter notes that “you have states where this device can be run by estheticians, it can only be run by MDs, it can only be run by PAs, and so obviously whoever is providing it to can affect the price. And I have even heard of places where it is just the front desk person who is operating them depending on the state laws.”
“If they said a receptionist can do it, that’s ridiculous, InMode shouldn’t say that,” a former InMode sales manager told The Capitol Forum. However, the sales manager said that they often did not disclose the actual requirements in whatever state they were selling in.
“If a dentist or someone didn’t know what their state regulations were, we would tell them not to worry about it. Just say, ‘look, you’re already working on the lower face, why not just get rid of wrinkles while you’re there? Once you are done fixing the smile, people go down to the plastic surgeon and spend thousands of dollars to fix wrinkles around the mouth. Why don’t you just bring all that business into your practice?’ We’d never got into what staff would need to do to get certified or licensed to do it,” the former sales manager said.
“If we were selling to a dentist and they knew it wasn’t in their scope of practice, we would tell the rep to just get out of the office,” they continued, “There are ways to get around those questions about the scope of practice, but we tell reps to get out if doctors are asking too many questions.”
Another former sales manager in a different territory confirmed this practice, telling The Capitol Forum that “every state has different types of laws on who can handle energy-based devices, which are also specific to medical specialties. Most of what InMode sells is Level Two and would require some special oversight, certification, or require it to be done in a medical facility. But we would not discuss those requirements when selling. We told customers that we are unable to be experts on every state or specialty.”
The Capitol Forum reached out to the dental boards of some of the states the former sales managers discussed and reviewed the licensing requirements for performing microneedling procedures like Morpheus8. None of the dental boards The Capitol Forum spoke with said that microneedling fell within the state’s scope of practice for either dentists or dental assistants.
Some states, like New York, have more specialized requirements for performing microneedling; to offer the service in New York, doctors and dentists are required to have an acupuncturist license, which requires at least 300 hundred hours of instruction and experience.
The former sales managers said that they often fielded complaints from doctors who felt duped into buying an InMode device. According to the sales managers, InMode often settled those cases quietly.
“A lot of issues with doctors seem to have been handled quietly,” one of the sales managers said, “They had so much momentum and didn’t want any lawsuits to kill the momentum.”
However, some lawsuits did get filed. A dentist in Massachusetts, for example, sued InMode for fraud, claiming that the sales representative lied to her about the legal requirements to operate the machine she was being sold.
According to the complaint, the dentist informed the InMode representative that “as she was a dentist, and she knew nothing about skin care or beauty fields” and that she was “not licensed to use any Laser Frequency radio devices.”
“Don’t worry, you don’t need a license or anything,” the InMode representative told the dentist, who ultimately found out she did need a license and was thus unable to use the machines in her practice, the complaint alleges.
Ultimately the dentist and InMode settled the case out of court.
Deceptive sales practices. According to the former employees of InMode, they often employed urgency-inducing tactics to get doctors to quickly agree to purchasing a device and agree to financing for it.
“If there was any backpedaling on the doctor saying he wanted to go to local bank, we would make them feel uncomfortable by saying this price is going away in a few days. We’d use urgency inducing tactics,” the former sales manager continued, “The fun story to tell is to tell them there is a device in Florida and the financing fell through, and we have to do this deal in 72 hours to get it off our books.”
“We would do a lot of things to get doctors to buy a device right now, like creating fake urgency,” another former sales manager said, “I would tell them, ‘Oh, hey, there is a device sitting in a warehouse in another state that can’t be delivered because something happened to the customer’s office. The company wants this thing off the books, so I will give you a deep discount, $15,000 or so to agree to buy it right now.’ It was such bullshit.”
This tactic appears to have gotten the med spa director in California to agree to purchase their med spa’s Morpheus8. According to the director, InMode “had been approaching us for a year to buy. They bought us cupcakes, lunch, etc.”
“We finally agreed to buy the Morpheus8. It would have been $160,000 with the tips, but they gave they gave us a discount on a showroom floor model. We got it for $110,000,” the director said; former sales managers told The Capitol Forum that they often offered bogus floor model discounts on new devices.
According to the director, sales of Morpheus8 treatments have not been as robust as they had initially thought, telling The Capitol Forum that sales dropped by about half after their first month, largely because “everyone in our area now has a Morpheus8 as well.”
The former InMode sales managers explained that they often painted much rosier pictures of the earnings potential of their devices to doctors.
“We had some accounts that did well, but it was like one out of hundred. Doctors would complain all the time about not getting any sales, not getting any revenue with our devices. Some would be left paying off their loan out of pocket,” another former sales manager said.
“We’d tell them that they won’t leave empty handed,” they continued, “That we’d help them sell the service and do marketing for them, but most of them time would leave accounts, especially non aesthetic practices, to figure it out on their own after a week or month of help.”
One former sales manager told The Capitol Forum that “we would tell customers, ‘Hey, put this thing in the corner and it should be an ATM for you.’ But honestly, of the offices that weren’t in aesthetics to begin with, I’d estimate about 40-50% of them fail or maybe break even.”
The former employees’ estimates of the success rates of clinics offering InMode treatments stands in contrast to marketing materials produced by the company.
In the same video in which the presenter notes that some states allow the receptionist to perform Morpheus8 procedures, the video estimates the average profit of a clinic offering the service between $36,782 and $68,644 per year, with “above average” providers that offer 25 InMode treatments each month earning over $300,000 in profit.
A complaint to the FTC by another dentist who was sold an InMode device underscores how a lack of ongoing support by InMode can leave doctors, some of whom reorganized their practice to accommodate the devices and took out large loans, in a lurch.
“I am a dentist and recently, I bought a radiofrequency facial remodeling device for $145,000 from InMode. A rep from the company sold me the device and set up the financing. The contract was a single page,” the complaint reads, “I also received an ROI worksheet to show how my investment will return capital into my business. I was all set for this device, I had my website redesigned to include it, I invested in marketing with their team and spent money on marketing materials.”
However, according to the complaint, the device began burning patients, and replacement pieces sent by InMode continued to break, leaving the dentist unable to operate the machine. Eventually, InMode stopped responding to the dentist’s pleas for help.
“I have already had over 5 new pieces and clearly the technology does not work so I do not simply want another new one,” the complaint concludes, “I have paid the bank for 2 months while my machine is not working. This company is not helping me with that either!”