What email scammers understand about lead qualification that most practices get backwards.

Field notes from Mike · Published 2026-07-22 · ~5 min read

There's a Microsoft Research paper I think about more than I'd like to admit. It's by Cormac Herley, and it's called "Why do Nigerian Scammers Say They Are from Nigeria?"

The question is a good one. If you're running a scam, why open with the single most obvious red flag on the internet? Why the spelling errors, the ludicrous story, the Nigerian prince? Wouldn't a polished, believable email catch more people?

More people, yes. More money, no. And the reason is the whole point.

The expensive part isn't the email

Sending emails is basically free. A scammer can blast millions of them for nothing. What's expensive is the next step: the actual human back-and-forth to work a target from "reply" to "wire transfer." That takes real time and real attention, and the scammer only has so much of it.

So their problem isn't getting responses. It's getting the wrong responses. Every skeptical person who replies, asks a few sharp questions, ties up an hour, and then figures it out is a dead loss. Herley calls these false positives, and they're what actually kill the operation's profit.

The absurd email is the fix. It's a filter. It repels anyone with enough sense to eventually catch on, so almost everyone who replies is already gullible enough to see it through. A believable email would get more total replies and make less money, because it would flood the scammer's expensive time with people who were never going to pay.

The bad grammar is a feature. It's doing the qualifying up front.

Now think about your front desk

Let me be very clear about one thing before anyone emails me: running a medical practice is not running a scam. You're changing lives for the better, not separating people from their money. The comparison ends at exactly one point, and it's the economics of attention.

Because that part carries over completely. Your cheap resource is the ad impression and the click. Your expensive resource is everything after: the front desk answering the phone, the coordinator working the follow-up, the provider's consultation calendar. That's finite, and it's costly.

And operational costs are real. You don't want your front desk spending hours on the phone with people who were never qualified. Worse, you don't want to book consultations for patients you genuinely can't help, because of cost, candidacy, or physical limitations, and then have to turn them away after everyone has already invested the time. Filtering isn't cynical here. It's respectful of everyone's time, including the patient's.

So when a practice tells me they want more leads, my first question is usually the opposite: how many of the leads you already get are quietly wasting your front desk's time? Because a campaign that generates a flood of the wrong people isn't a win. It fills your expensive human capital with false positives, wrong insurance, wrong budget, wrong expectations, people who were never going to book.

The best campaigns I've ever run did the unglamorous thing the scammer does: they filtered as hard as they attracted.

Repelling the wrong patient is a feature

This is deeply counterintuitive to most practice owners, because every instinct says more leads, more reach, more volume. But the practices that actually fill their calendars with the right patients do the opposite on purpose:

They put pricing posture in the ad copy, so price shoppers self-select out before they ever call. "Rhinoplasty from $X" loses you the bargain hunters and keeps the serious ones. That's the point.

They say the quiet part out loud, cash-pay, out-of-network, so the person expecting insurance to cover it doesn't tie up a consult slot discovering it won't.

They speak to a specific patient, so the wrong ones scroll past and the right ones feel seen.

Every one of those choices reduces raw lead volume. And every one of them raises the density of qualified patients in what's left, which means your expensive human capital, the front desk, the coordinator, the calendar, spends its time on people who actually book. Fewer leads, more booked consults. That trade is almost always the right one.

The filter should start at the ad, not the front desk

Here's the part most practices miss: filtering isn't one moment. It's a chain, and it compounds at every stage. The best filtering happens as early as possible, because the cost of removing the wrong person rises at every step down the funnel.

It starts at the ad, and this is the one people get most wrong. Your ad platform optimizes for exactly the outcome you tell it to. Tell Google or Meta to maximize "leads," and it will dutifully go find the people most likely to fill out a form, which is not the same as the people most likely to book and pay. Optimize for cheap leads and the algorithm becomes a machine for attracting the wrong patients. Point it at qualified, booked consultations instead, and it starts filtering for you before a single click is paid for. The ad is your first and cheapest filter, and most practices have it aimed at the wrong target.

It continues on the landing page and form. Pricing posture, honest expectations, and a couple of qualifying questions do more filtering, and the person who was never a fit self-selects out before they ever reach a human.

It continues on the phone. Now a coordinator qualifies, but if the earlier filters did their job, most of the unqualified are already gone, and the front desk spends its time on real candidates.

And it continues through the consult and the provider, the final filter for candidacy, and the most expensive room in the building.

Each stage is a filter, and the cost of using it goes up at every step. A wrong patient stopped at the ad costs you nothing. A wrong patient who makes it into the provider's chair has already consumed your single most expensive resource. So the goal was never to filter harder at the front desk. It's to filter earlier, so the front desk and the provider almost never have to.

The number that gives it away

The reason this is so easy to get wrong is that lead volume and cost per lead are the easy numbers to see, and they reward the believable-email strategy. Attract everyone, watch the lead count climb, feel good about the report.

The number that tells the truth is cost per booked, attended consultation. When you manage to that, the logic flips, and you start making the scammer's move on purpose: happily repelling the people who would have cost you more to disqualify than they'd ever be worth.

The Nigerian prince figured this out a long time ago. The email isn't badly written. It's precisely written, to keep the wrong people from ever picking up the phone.

Your marketing should be doing the same thing. Just, you know, for good.

Mike Funkhouser is the founder of Practice Growth Co, a healthcare marketing agency focused on patient acquisition for specialty medical practices. Source: Cormac Herley, "Why do Nigerian Scammers Say They Are from Nigeria?", Microsoft Research (WEIS 2012).