By Marcus Goh, Director, PULSE Digital
Google can change your ad account settings without asking, and for a Singapore clinic that matters because those changes are optimised for Google’s platform metrics, not for HCSA or SMC ECEG compliance. A newly auto-generated headline can pull language straight from your landing page, including phrases your compliance team never signed off for public advertising.
Why does Google automatically change ad account settings?
Google Ads has a feature called auto-apply recommendations, switched on by default in most accounts unless someone has gone into Account Settings and turned it off. It applies changes such as broadening keyword match types, generating new ad headlines and descriptions, restructuring bidding strategies, and editing asset groups inside Performance Max campaigns.
These changes are driven by an account’s Optimisation Score, a Google metric that rewards accounts for adopting more automation. A higher score is not the same as a compliant ad. Google’s recommendation engine has no concept of the Healthcare Services Act, the SMC Ethical Code and Ethical Guidelines, or the Health Products Act. It only knows what tends to lift click through rate.
What compliance risks does this create for a medical or aesthetic clinic?
The main risk is that auto-generated ad copy can surface content your landing page contains for informational purposes but which should never appear in a public advertisement. Performance Max in particular scrapes text and images from your website to build asset combinations automatically.
If your website mentions a specific treatment outcome, a patient quote, a limited-time offer, or the name of a medical device, that language can end up in an ad headline within days, without a human reviewing it first. This is not theoretical. It is how the automation is designed to work, and it is why clinics running Performance Max need tighter internal review than a standard search campaign requires.
How do HCSA, SMC ECEG and HSA rules actually apply to ad copy?
The Healthcare Services Act (HCSA) sets out what a licensed healthcare service may publish in an advertisement, and it prohibits patient testimonials, before and after imagery, comparative superiority claims, and promotional pricing framed with urgency. The SMC Ethical Code and Ethical Guidelines (ECEG) apply on top of this for registered doctors, restricting how a practitioner’s own results or expertise can be described publicly. The Health Products Act, enforced by HSA, restricts naming specific medical devices or therapeutic products in advertising directed at the public.
None of these bodies review your Google Ads account. The obligation sits with the clinic and the advertising practitioner, which means the compliance check has to happen inside your own workflow, ideally before an ad goes live rather than after MOH or SMC raises a query.
| Auto-applied ad element | Compliance risk | Recommended action |
|---|---|---|
| Auto-generated headlines from landing page text | May include outcome claims or price language restricted under HCSA | Review every new headline before approval, disable auto-apply for ad copy |
| Performance Max asset group images | May pull before/after style imagery from a gallery page | Audit image library, remove comparison imagery from source pages |
| Broad match keyword expansion | Can trigger ads on searches implying guaranteed results | Monitor search terms report weekly, add negative keywords |
| Automated bidding strategy changes | Not a compliance issue directly, but shifts budget toward auto-generated assets | Review bid strategy changes in Change History monthly |
How should a clinic audit Google Ads changes for compliance?
- Open Google Ads, go to Tools and Settings, then Automatically Applied Recommendations, and switch off any category involving ad copy, assets, or landing pages.
- Check the Change History report at account level every month, filtering for anything applied by Google rather than by your team.
- Cross-check every new headline, description, and image asset against your clinic’s internal HCSA and SMC ECEG checklist before it goes live.
- Assign one named person, whether in-house marketing manager or your agency contact, to sign off on ad copy changes before publication.
- Keep a dated record of each review. If MOH or SMC ever asks about a specific advertisement, a documented review trail is far stronger than saying the copy was auto-generated.
This is a small monthly task compared with the cost of a compliance query landing on the clinic’s desk after an advertisement has already run for weeks.
Frequently Asked Questions
Does turning off auto-apply hurt ad performance?
Who is responsible if Google auto-generates non-compliant ad copy?
How often does Google change ad account settings?
Does turning off auto-apply hurt ad performance?
Who is responsible if Google auto-generates non-compliant ad copy?
How often does Google change ad account settings?
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About the author :
Marcus is the Founder and Director of PULSE Digital, a Singapore performance-marketing agency that helps businesses win visibility across Google Ads, Meta, SEO and AI search (AEO/GEO). PULSE works with clients across e-commerce, professional services and regulated, high-trust industries, with a particular specialisation in advertising compliance.
