A Louisiana healthcare brand was spending $18K/month on Google Ads and celebrating a 4.8x ROAS. The real number was 2.1x. Half the conversions were repeat patients who would have booked anyway.

The ad account was counting every appointment booked through the website as an ad-driven conversion. No exclusion lists for existing patients. No proper attribution windows. Patients who had been coming for years and simply clicked a search ad before booking were inflating the numbers. The dashboard showed $86K in ad-attributed revenue. Actual incremental revenue from ads was closer to $38K. At $18K spend, real ROAS was 2.1x — barely above breakeven.

The agency had recommended scaling to $30K/month based on the inflated numbers. At real ROAS of 2.1x, that scale would have burned cash. The dashboard was not just wrong — it was a road map to financial trouble.

We rebuilt attribution from scratch. Patient exclusion lists. Proper conversion windows. New patient vs. returning patient tracking. Then restructured campaigns around audiences that actually needed to be acquired. Real ROAS climbed to 3.6x within 90 days because spend went where it mattered. GOSH Digital manages paid media for Baton Rouge businesses with one standard: the bank account is the only scoreboard.