The rapid expansion of telehealth has transformed how care is delivered across the United States, but it’s also creating new legal risks for licensed professionals. Doctors, therapists, nurse practitioners, and other healthcare providers are increasingly offering services to patients outside their home state, often without fully understanding how licensing laws apply across jurisdictions. And as state boards begin to scrutinize this trend more closely, professionals may find themselves unintentionally violating regulations they never knew existed.

In most states, a provider must be licensed in the state where the patient is physically located at the time of service, not just where the provider practices. That means a single virtual session with an out-of-state patient can constitute the unauthorized practice of medicine, therapy, or another regulated profession, potentially triggering investigation, fines, or disciplinary action.

Joseph Lento, founder of Lento Law Firm and lawyer for licensed professionals, says these risks are increasing as state boards begin enforcing geographic licensing boundaries with greater precision.

Lento indicates, “Many professionals wrongly assume that telehealth removes geographic limitations on licensure, but that’s not the case. Boards are increasingly investigating providers for out-of-state sessions, even those conducted in good faith. Legal counsel can help assess your multi-state exposure and take corrective action before the situation escalates.”

During the early years of the COVID-19 pandemic, many states issued emergency waivers allowing cross-state telehealth services. But as those waivers expire, enforcement has returned to pre-pandemic norms, and in some cases, become more aggressive. Several states have now launched investigations into providers who failed to obtain proper licensure before conducting telehealth visits, even if the services were brief, non-invasive, or performed in good faith.

While some regions have created telehealth-specific compacts or expedited licensing pathways, these systems remain inconsistent and difficult to navigate. A provider may be licensed in one compact state but still out of compliance when working with a patient in another, depending on how each board interprets scope, location, and supervision rules.

“We advise clients to verify licensure requirements before each session, especially when treating patients who have moved or traveled. Even when participating in licensure compacts, variations in interpretation between states can lead to violations. Legal guidance can ensure you remain compliant while continuing to serve your patient base across borders,” Lento reports. 

Mental health professionals, in particular, are at heightened risk. Many counselors, psychologists, and therapists now work with patients who move frequently, travel, or seek services across state lines. Even when a provider maintains a long-standing therapeutic relationship, continuing care without proper licensure in the patient’s current state can raise red flags. Some boards have begun tracking complaints through digital footprints or insurance billing data, triggering disciplinary notices months after the sessions occurred.

In these cases, intent often matters little. Licensing boards typically evaluate only whether a violation occurred, not whether it was deliberate or whether harm resulted. Even unintentional practice without authorization can result in public discipline or license restrictions.

According to Lento, “We’ve represented numerous professionals who were unaware that continuing care for traveling patients could expose them to cross-jurisdictional enforcement. Unfortunately, boards do not always consider context or intent before taking action. An experienced licensing attorney can help mitigate penalties and defend your right to practice.”

Despite these risks, the legal landscape remains fragmented. Federal legislation on telehealth licensing has stalled, leaving providers to navigate a patchwork of state rules. And while most boards recognize the value of telehealth, they remain committed to enforcing state-specific licensure as a matter of public protection and professional accountability.

Disclaimer and Disclosure: This article is an opinion piece for informational purposes only. Meditech Wire and its affiliates do not take responsibility for the views expressed. Readers should conduct independent research to form their own opinions.