(1) Why the Board Investigates

The NCMB was established to protect the public, and one of its primary tools for doing so is its authority to investigate and discipline licensees whose professional conduct or ability to practice medicine may fall below accepted standards. That authority is granted by the Medical Practice Act (N.C.G.S. Chapter 90).

Complaints and other information come to the Board from a wide range of sources, including patients and their families, other licensees and healthcare professionals, law enforcement, hospitals and other healthcare institutions (which are required to report changes in staff privileges), malpractice insurance carriers (which report professional liability payments), federal and state agencies, and the National Practitioner Data Bank. The Board also accepts and may investigate anonymous complaints and tips. Receiving a notice from the Board does not mean that a violation has been found or that disciplinary action is forthcoming—it means the Board has received information it is required to evaluate.

(2) Initial Notice and Your Response

In most cases, when the Board opens an investigation, it provides the licensee with written notice that an investigation has begun. There are limited circumstances in which notice is withheld—generally where providing it would jeopardize the investigation itself.

After notice is issued, the Board contacts the licensee to obtain a response. Depending on the matter, this may involve receiving a copy of the complaint and being asked to respond in writing, or being interviewed by a Board investigator. The licensee is required to respond within the time permitted under 21 NCAC 32N .0107. In many cases, the written response is the licensee’s most significant opportunity to present their perspective, provide context, and bring any mitigating factors to the Board’s attention. A clear and thorough response, supported by relevant medical records or documentation, frequently provides the Board with everything it needs to complete its review. Whether and how to respond—and what to include—are questions worth discussing carefully with counsel before submitting anything.

(3) Staff Review and Medical Director Evaluation

Once the licensee’s response is received, Board staff begins a thorough evaluation of the case. Any matter that involves quality of care is forwarded to the Board’s Office of the Medical Director (OMD), which is staffed by physicians and a physician assistant. Depending on the specialty area involved, the OMD may assess the case directly or forward it to an independent reviewer who practices in the same specialty as the licensee under investigation. The OMD then makes recommendations for Board action in each case. Board attorneys review each case as well and make recommendations for Board action.

(4) Senior Staff Review Committee and Board-Level Review

After staff-level review, each case is examined by the Senior Staff Review Committee (SSRC), a committee made up of the chiefs and managers of the Complaints, Investigations, and Legal departments, as well as the OMD. The SSRC reviews the case and reaches a recommendation for Board action. The SSRC does not have to, but may, follow the recommendations by OMD or Board attorneys.

For cases where some type of Board action is recommended—whether public or private—the case proceeds to the Board’s Disciplinary Committee for a further round of review. The committee examines and discusses each assigned case and makes final recommendations, which again may or may not align with what the SSRC recommended.

The final step in the process is review by the full Board. The Board may accept the committee recommendation, or it may determine that additional information is needed before reaching a decision. In those situations, the Board may request that the licensee attend a confidential interview with a panel of Board members, or that the licensee obtain a specific type of assessment—neurologic, substance abuse, clinical competence, or otherwise. The Board makes its final determination only when it is satisfied it has the information it needs. The entire process—from initial contact through final Board action—may take six months or more.

If you are a North Carolina licensee who has received notice of an NCMB investigation, or if you have questions about how the Board’s process may apply to your situation, we would be glad to discuss your matter with you. You may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

*Disclaimers: Thoughts shared here do not constitute legal advice nor do they form an attorney-client relationship.  All digital presentations by our firm or its attorneys are provided as a public informational resource.  Although intended to be correct and up to date as of the date posted, we cannot guarantee the accuracy of posted information, especially as it relates to individual situations.  We do not routinely update such information.  To determine up-to-date information about the subject matter of this information and proper application to a specific situation, it is important that you consult your healthcare attorney.  Our communications of information through the Internet shall not constitute “presence,” “doing business” or the practice of law in any location, even when a specific state or its laws/rules are referenced.  Our firm maintains offices in Georgia and no other state. Our attorneys are licensed in some, but not all, states.  For each client engagement we accept, our firm undertakes best efforts to ensure we are aware of and adhere to applicable jurisdictional requirements, which may include reviewing local rules, conducting relevant research and collaborating with, or referring a matter to, a local attorney.

Senate Bill (SB 207) proposes to provide additional rights to licensing applicants whose applications have been denied based on a prior criminal record. If a licensing board intends to deny an application based on a prior criminal record, the bill requires the board to deny or revoke the license only if the felony or “covered misdemeanor” directly relates to the occupation, but the board cannot deny or revoke a license solely for the conviction of a felony or “covered misdemeanor.” Under the bill, a “covered misdemeanor” includes any misdemeanor conviction within five years of submitting the licensing application and any applicable misdemeanor conviction regardless of the date of conviction. These applicable misdemeanor convictions include domestic violence crimes, sexual crimes, theft, and serious traffic offenses, including reckless driving, DUIs, etc.

If a licensing board intends to deny a licensing application based on the applicant’s criminal record, the applicant must be entitled to a hearing before the licensing board before the denial can occur. At the hearing, the applicant can present written or oral testimony of character witnesses. The licensing board is then required to issue a decision within 60 days of the hearing.  If a licensing board denies an application based on an applicant’s criminal record, the licensing board is required to make specific written findings specifying the applicant’s convictions and other factors that justify and basis and rationale for the application denial. The factors that the licensing board must consider in determining whether a felony or covered misdemeanor directly related to the licensing occupation already exist under Georgia law, including the nature and seriousness of the offense, the length of time elapsed since the commission of the offense, the applicant’s age at the time the offense was committed, other mitigating circumstances, and evidence of an applicant’s rehabilitation and present fitness. SB 207 also adds certain factors for licensing boards to consider in determining an applicant’s rehabilitation and present fitness to perform the licensing occupation. These factors include the completion of the criminal sentence, testimonials and recommendations, education and training, employment history, employment aspirations, any affidavits or other written documents, including character references, and any other information about rehabilitation that the applicant submits to the licensing board.

SB 207 explicitly requires licensing boards to provide “individualized consideration” of an applicant’s criminal record and prohibits licensing boards from denying licensing applications automatically based on an applicant’s criminal record. The bill also requires licensing boards to notify applicants in writing of specific issues in their application if the applicant’s criminal record includes issues that may or will prevent the licensing board from issuing a license to the applicant. After receiving such notice, the applicant will then have 30 days to correct any inaccuracy by submitting additional evidence of mitigation or rehabilitation for the licensing board to consider.

The bill also allows any individual with a criminal record to petition the licensing board at any time for a predetermination of whether the individual’s criminal record will disqualify them from obtaining a license. The licensing board must use the same factors to determine whether the applicant’s criminal record supports an adverse decision, including a denial. The licensing board may only predetermine that the petitioner’s criminal record is grounds for a denial only after the licensing board has held a hearing, and the individual has had an opportunity to present evidence at the hearing. If the bill becomes law, these requirements will become effective on July 1, 2027, and apply to licensing applications submitted on or after July 1, 2027.

If you are planning to apply for a medical license or nursing license or would like to discuss this blog post, you may contact our healthcare law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

*Disclaimers: Thoughts shared here do not constitute legal advice nor do they form an attorney-client relationship.  All digital presentations by our firm or its attorneys are provided as a public informational resource.  Although intended to be correct and up to date as of the date posted, we cannot guarantee the accuracy of posted information, especially as it relates to individual situations.  We do not routinely update such information.  To determine up-to-date information about the subject matter of this information and proper application to a specific situation, it is important that you consult your healthcare attorney.  Our communications of information through the Internet shall not constitute “presence,” “doing business” or the practice of law in any location, even when a specific state or its laws/rules are referenced.  Our firm maintains offices in Georgia and no other state. Our attorneys are licensed in some, but not all, states.  For each client engagement we accept, our firm undertakes best efforts to ensure we are aware of and adhere to applicable jurisdictional requirements, which may include reviewing local rules, conducting relevant research and collaborating with, or referring a matter to, a local attorney. 

House Bill 1275 (HB 1275) proposes to regulate stem cell treatments that are intended for regenerative treatments, not for human research purposes. The bill states that physicians, physician assistants, or nurse practitioners can perform non-FDA-approved stem cell therapies if the therapies are used for “treatment or procedures that are within the scope of practice of the physician, physician assistant, or nurse practitioner, so long as the patient is advised and signs a consent form.” As such, stem cell therapies would require the patient to obtain informed consent before agreeing to proceed with stem cell therapy.

HB 1275 also lists requirements for human stem cells before they can be included as part of stem cell therapy. Under the bill, human stem cells must be retrieved, manufactured, and stored in an FDA-registered facility. The facility can be in Georgia or anywhere else in the world. The facility can also be certified and accredited by several entities other than the FDA, including the World Marrow Donor Association.

The bill also requires physicians, physician assistants, or nurse practitioners to include specific language laid out in the bill in any advertisement if they intend to perform stem cell therapy. The advertisement language notifies patients that the stem cell therapy is not FDA-approved and encourages patients to consult with their primary care provider before undergoing any stem cell therapy. If a physician, physician assistant, or nurse practitioner violates any provision of this bill, the provider may be subjected to disciplinary action from the Georgia Medical Board or Georgia Nursing Board.

If you are planning to administer stem cell treatments as part of your practice or would like to discuss this blog post, you may contact our healthcare law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

*Disclaimers: Thoughts shared here do not constitute legal advice nor do they form an attorney-client relationship.  All digital presentations by our firm or its attorneys are provided as a public informational resource.  Although intended to be correct and up to date as of the date posted, we cannot guarantee the accuracy of posted information, especially as it relates to individual situations.  We do not routinely update such information.  To determine up-to-date information about the subject matter of this information and proper application to a specific situation, it is important that you consult your healthcare attorney.  Our communications of information through the Internet shall not constitute “presence,” “doing business” or the practice of law in any location, even when a specific state or its laws/rules are referenced.  Our firm maintains offices in Georgia and no other state. Our attorneys are licensed in some, but not all, states.  For each client engagement we accept, our firm undertakes best efforts to ensure we are aware of and adhere to applicable jurisdictional requirements, which may include reviewing local rules, conducting relevant research and collaborating with, or referring a matter to, a local attorney. 

On March 31, 2026, our firm wrote a blog post about a bill in the Georgia General Assembly that proposed to regulate ketamine clinics. On May 12, 2026, Georgia Governor Brian Kemp signed this bill, meaning the bill is set to become law on July 1, 2026, unless the bill gives another effective date for certain portions of it. This updated blog post discusses the new law that will regulate ketamine clinics. If you are planning to administer ketamine in your practice, would like to set up a ketamine clinic, or would like to discuss this blog post, you may contact our healthcare law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

The new law, House Bill 717 (HB 717), will regulate facilities that administer “psychedelic-assisted treatment and therapy,” which includes ketamine that is administered intravenously. “Psychedelic-assisted treatment and therapy” is defined as any treatment or therapy using psychedelic, dissociative, or other related substances that can produce hallucinations or other similar feelings. The new law will also cover other treatments similar to ketamine, including Spravato®. The Georgia Medical Board will be required to establish rules and regulations by no later than the end of 2026 that govern how ketamine is prescribed and administered in the clinic, what equipment and certifications are required for a clinic, and who can provide psychedelic-assisted treatment and therapy.

HB 717 also requires that, effective July 1, 2027, clinics will file for a two-year license with the Georgia Medical Board so the clinic can administer ketamine and other psychedelic-assisted treatment and therapy. It will also require these clinics to be owned only by physicians or certified registered nurse anesthetists (CRNAs), but this requirement will not apply to any existing clinic that is in existence and operational on July 1, 2026, and existing clinics will still need to comply with the other requirements in the new law. Licensed clinics will also have certain requirements, including executing an agreement with a nearby hospital to ensure there is backup for potential complications, and that patients can be transferred to that hospital if those complications arise.

The new law also limits who can administer ketamine and other psychedelic-assisted treatment and therapy to physicians with advanced airway management training; CRNAs under physician direction; anesthesiologist assistants under the direct supervision of a licensed anesthesiologist; nurse practitioners with airway management training, at least five years of clinical experience, with a nurse protocol agreement, and with express written Board approval; or physician assistants with airway management training, at least five years of clinical experience, with a job description, and with express written Board approval. Before the treatment is administered, the new law also requires the administering provider to review the prescription drug monitoring program and report the administration of any psychedelic-assisted treatment and therapy to the prescription drug monitoring program. HB 717 also provides criminal penalties for those who operate a clinic without a license, including imprisonment of 1-5 years or fines of $1,000-$5,000.

If you are planning to administer ketamine in your practice, would like to set up a ketamine clinic, or would like to discuss this blog post, you may contact our healthcare law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

*Disclaimers: Thoughts shared here do not constitute legal advice nor do they form an attorney-client relationship.  All digital presentations by our firm or its attorneys are provided as a public informational resource.  Although intended to be correct and up to date as of the date posted, we cannot guarantee the accuracy of posted information, especially as it relates to individual situations.  We do not routinely update such information.  To determine up-to-date information about the subject matter of this information and proper application to a specific situation, it is important that you consult your healthcare attorney.  Our communications of information through the Internet shall not constitute “presence,” “doing business” or the practice of law in any location, even when a specific state or its laws/rules are referenced.  Our firm maintains offices in Georgia and no other state. Our attorneys are licensed in some, but not all, states.  For each client engagement we accept, our firm undertakes best efforts to ensure we are aware of and adhere to applicable jurisdictional requirements, which may include reviewing local rules, conducting relevant research and collaborating with, or referring a matter to, a local attorney. 

Medical Assistants Are Able to Perform a Very Limited Amount of Medical Tasks Under Georgia Law, and Most Med Spa Services Are Not Within This Limited Amount of Medical Tasks.

The Georgia Medical Board’s regulations outline what medical tasks medical assistants can do. Under the regulations, physicians can delegate the following tasks to medical assistants: Subcutaneous and intramuscular injections, obtaining vital signs, administering nebulizer treatments, or removing sutures and changing dressings. Although a physician is not required to be onsite for a medical assistant to perform vital signs, a physician, physician assistant, or nurse practitioner must be onsite for a medical assistant to administer subcutaneous and intramuscular injections, to administer nebulizer treatments, and to remove sutures and change dressings. Medical assistants are also allowed only to perform services for which they have been properly trained. The Medical Board’s regulations also state physicians commit unprofessional conduct if they delegate to medical assistants the ability to perform Botox and/or dermal filler injections.

The Medical Board recently confirmed medical assistants’ limited ability to perform medical tasks. In its April 9, 2026 meeting minutes, the Medical Board stated that medical assistants are not allowed to oversee IV infusions, insert an IV catheter and start an infusion, or administer injectable medications without supervision.

If you are a medical assistant wanting to set up a med spa, plan to hire a medical assistant as part of your med spa practice, or would like to discuss this blog post, you may contact our healthcare law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

*Disclaimers: Thoughts shared here do not constitute legal advice nor do they form an attorney-client relationship.  All digital presentations by our firm or its attorneys are provided as a public informational resource.  Although intended to be correct and up to date as of the date posted, we cannot guarantee the accuracy of posted information, especially as it relates to individual situations.  We do not routinely update such information.  To determine up-to-date information about the subject matter of this information and proper application to a specific situation, it is important that you consult your healthcare attorney.  Our communications of information through the Internet shall not constitute “presence,” “doing business” or the practice of law in any location, even when a specific state or its laws/rules are referenced.  Our firm maintains offices in Georgia and no other state. Our attorneys are licensed in some, but not all, states.  For each client engagement we accept, our firm undertakes best efforts to ensure we are aware of and adhere to applicable jurisdictional requirements, which may include reviewing local rules, conducting relevant research and collaborating with, or referring a matter to, a local attorney. 

(1) The APRN–Delegating Physician Relationship

The position statement reaffirms Georgia’s nurse protocol framework under O.C.G.A. § 43-34-25 and Ga. Comp. R. & Regs. 360-32-.04 and 360-32-.05. A physician may delegate to an APRN only where the physician’s specialty area is comparable to the APRN’s specialty—meaning services the physician regularly provides in his or her own practice—and the parties maintain a compliant nurse protocol agreement. The delegating physician must conduct direct onsite observation at least annually, perform quarterly medical-record reviews, and retains ultimate responsibility for ensuring delegated acts are clinically appropriate, properly supervised, and adequately documented.

(2) Compensation Prohibition: APRN Employment of the Delegating Physician

Georgia law prohibits a physician from being employed by an APRN—alone or in combination with others—when that physician is required to supervise the employing APRN, with limited exceptions for certain institutional settings. The Board states that it interprets this prohibition broadly, extending it beyond W-2 or 1099 classifications to any compensation—monetary or non-monetary—paid by an APRN or APRN-owned entity to a physician in exchange for serving in the delegating role. How this broad interpretation applies to various indirect compensation and entity-ownership structures raises questions the position statement does not fully resolve. O.C.G.A. § 43-34-25(n); Ga. Comp. R. & Regs. 360-32-.04(5)

(3) CRITICAL CLARIFICATION: Third-Party Matching and Staffing Platforms

The position statement addresses use of third-party companies—such as platforms marketed as “Collaborating MD’s/DO’s,” “APRNMatch,” or “NP Collaborator”—to obtain a delegating physician. The Board states it will evaluate these arrangements based on substance rather than form: if an APRN is paying a third-party company for access to a delegating physician, and that physician is compensated through the arrangement to supervise the APRN, the Board views the arrangement as prohibited regardless of the intermediary structure. The involvement of a matching, staffing, or contracting company does not cure the prohibition if the practical result is that the APRN—directly or indirectly—is paying for the delegating physician relationship. How this standard applies to employer-paid or practice-level physician compensation arrangements involves factual questions the statement does not fully address.

(4) The PA–Supervising Physician Relationship and Public Disclosure

Georgia PAs must have a Board-approved supervising physician and a Board-approved job description. The prohibition on a physician being employed by the PA he or she supervises mirrors the APRN framework, with a narrow grandfather exception for arrangements approved before July 1, 2009.

The position statement also requires all licensees—APRNs and PAs—to clearly post the identity of the delegating or supervising physician and contact information in a manner accessible to the public without restriction.

If you would like to discuss how the Georgia Medical Board’s position statement applies to your practice structure, provider agreements, or compliance program, or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

*Disclaimers: Thoughts shared here do not constitute legal advice nor do they form an attorney-client relationship.  All digital presentations by our firm or its attorneys are provided as a public informational resource.  Although intended to be correct and up to date as of the date posted, we cannot guarantee the accuracy of posted information, especially as it relates to individual situations.  We do not routinely update such information.  To determine up-to-date information about the subject matter of this information and proper application to a specific situation, it is important that you consult your healthcare attorney.  Our communications of information through the Internet shall not constitute “presence,” “doing business” or the practice of law in any location, even when a specific state or its laws/rules are referenced.  Our firm maintains offices in Georgia and no other state. Our attorneys are licensed in some, but not all, states.  For each client engagement we accept, our firm undertakes best efforts to ensure we are aware of and adhere to applicable jurisdictional requirements, which may include reviewing local rules, conducting relevant research and collaborating with, or referring a matter to, a local attorney.

Background

Peptides are smaller versions of proteins that may provide pro-aging support, anti-inflammatory, or muscle-building properties. Although popular peptides include weight loss drugs such as semaglutide or tirzepatide, certain peptides such as BPC-157 and Sermorelin are currently being used at med spas for therapeutic purposes. Peptides that are used for therapeutic purposes are not FDA-approved, so they are considered off-label use.

Section 503A of the Food, Drug & Cosmetic Act allows licensed compounding pharmacies to compound drugs for patients who have a valid prescription. The FDA has created three categories of bulk drugs substances, each of which carries its own significance. Bulk drug substances in Category 1 are eligible for inclusion on the 503A Bulks List, and compounding pharmacies can compound drugs with bulk drug substances in this category. Bulk drug substances in Category 2 contain “significant safety risks” associated with compounding, which means pharmacies cannot compound drugs containing substances in Category 2 without risking enforcement actions against them. Bulk drug substances in Category 3 have insufficient information for the FDA to evaluate them.

Popular peptides, including BPC-157 and Thymosin Beta-4, are currently in Category 2 because the FDA has cited certain risks that these peptides can invoke an immune response in the body, but the agency also lacks enough information about whether the peptides would harm humans when administered to them.

The FDA has issued warning letters to pharmacies for compounding drugs containing substances in Category 2. Although enforcement has been primarily against pharmacies or manufacturers for compounding and selling drugs with certain peptides in them, we are monitoring whether the FDA will seek enforcement actions against med spas and other practices for offering peptides to patients.

Recently, in February 2026, Secretary of Health and Human Services Robert F. Kennedy, Jr. has admitted to using peptides and has pushed for the FDA to loosen regulations on popular peptides.

FDA Announcement

On April 15, 2026, the FDA announced it will hold a meeting from July 23-24, 2026, to discuss popular peptides, including BPC-157, TB-500, KPV, and MOTs-C, for inclusion on the 503A Bulks List. If these peptides are included on the 503A Bulks List, this means that the FDA has reclassified them into Category 1, which means compounding pharmacies can freely compound drugs with these peptides pursuant to a valid prescription without risk of an enforcement action, but it does not mean that these peptides are now FDA-approved. Our firm will continue to monitor the results of this meeting.

If you need assistance setting up a med spa that offers peptides, have questions about whether your practice is compliant with the various laws and regulations surrounding peptides, or would like to discuss this blog post, you may contact our healthcare law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

*Disclaimers: Thoughts shared here do not constitute legal advice nor do they form an attorney-client relationship.  All digital presentations by our firm or its attorneys are provided as a public informational resource.  Although intended to be correct and up to date as of the date posted, we cannot guarantee the accuracy of posted information, especially as it relates to individual situations.  We do not routinely update such information.  To determine up-to-date information about the subject matter of this information and proper application to a specific situation, it is important that you consult your healthcare attorney.  Our communications of information through the Internet shall not constitute “presence,” “doing business” or the practice of law in any location, even when a specific state or its laws/rules are referenced.  Our firm maintains offices in Georgia and no other state. Our attorneys are licensed in some, but not all, states.  For each client engagement we accept, our firm undertakes best efforts to ensure we are aware of and adhere to applicable jurisdictional requirements, which may include reviewing local rules, conducting relevant research and collaborating with, or referring a matter to, a local attorney.

First Step: Request and Review Your Employer’s Bylaws or Other Policies to Determine What Your Rights Are in Response to a Peer Review Action.

Employers normally have due process policies related to peer review actions, and these policies are usually located in the employer’s internal bylaws. The bylaws govern how to respond to a peer review action and what rights you should have during a peer review action. These rights include responding to the peer review action, having access to your personnel file, among others.

Second Step: Hire an Attorney so You Can Develop a Proper Response Strategy, Timely Respond to the Peer Review Action, and Preserve Your Defenses.

When you receive a notice of a peer review action, the notice should allow you to respond to the allegations within a certain timeframe, such as fifteen days from the receipt of notice. You should hire an attorney immediately after you receive a notice of a peer review action so that your attorney can help advise you on what steps you need to take to preserve your due process rights and to assess what defenses you may have to the allegations and to identify any potential deficiencies in how the employer procedurally notified you of the peer review action or other adverse actions against you. If you are reluctant to hire an attorney after you receive a notice of a peer review action, you should respond to the allegations in the peer review action within the prescribed timeframe in the notice to lay out your side of the story to your employer and also to preserve certain defenses, including due process defenses, before you decide to hire an attorney.

If you need assistance responding to a peer review action from your employer or would like to discuss this blog post, you may contact our healthcare law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

*Disclaimers: Thoughts shared here do not constitute legal advice nor do they form an attorney-client relationship.  All digital presentations by our firm or its attorneys are provided as a public informational resource.  Although intended to be correct and up to date as of the date posted, we cannot guarantee the accuracy of posted information, especially as it relates to individual situations.  We do not routinely update such information.  To determine up-to-date information about the subject matter of this information and proper application to a specific situation, it is important that you consult your healthcare attorney.  Our communications of information through the Internet shall not constitute “presence,” “doing business” or the practice of law in any location, even when a specific state or its laws/rules are referenced.  Our firm maintains offices in Georgia and no other state. Our attorneys are licensed in some, but not all, states.  For each client engagement we accept, our firm undertakes best efforts to ensure we are aware of and adhere to applicable jurisdictional requirements, which may include reviewing local rules, conducting relevant research and collaborating with, or referring a matter to, a local attorney. 

(1) What Is the Difference Between Coaching and Therapy?

Psychotherapy and other licensed clinical mental health services are regulated services.  In Florida, for example, psychotherapy may be provided by a licensed clinical social worker, licensed mental health counselor, licensed marriage and family therapist, or a licensed physician or physician assistant operating within their authorized scope of practice.  These services are governed by professional licensing statutes, including Chapter 491 and Chapter 458 of the Florida Statutes.  Licensed providers are subject to board oversight, scope of practice limitations, and professional discipline.

Coaching, by contrast, is not a licensed profession in Florida or most other states.  There is no state licensing board for coaches, no regulated scope of practice, and no statutory definition of “coaching” as a health care service.  Coaching is generally understood to be a forward-focused, goal-oriented relationship that supports a client’s personal or professional development—without diagnosing, treating, or managing mental health conditions.  The International Coaching Federation and similar bodies offer voluntary credentials, but these are not state-issued licenses and do not carry the legal weight of a professional license.  When an individual is a licensed practitioner and wishes to also provide coaching, it is very important to discuss the risks of doing so with counsel before providing coaching.  Patients may not appreciate the distinction, which can pose compliance concerns with the practitioner.

(2) Why the Distinction Matters Legally

When a licensed mental health provider also offers coaching, two legal risks emerge if the services are not clearly distinguished.

First, there is a risk of unlicensed practice.  Florida’s mental health licensing statutes broadly define the “practice” of psychotherapy and counseling to include services that a court or licensing board might find are effectively therapeutic, even if labeled as coaching.  If a coaching relationship involves a client presenting with mental health symptoms and the coach responds in ways that constitute assessment or treatment—regardless of what the relationship is called—the provider may be found to have engaged in the unauthorized practice of a licensed profession.  Florida’s Section 491.014 imposes penalties for unlicensed practice, and the same individual can face discipline on their professional license for conduct that blurs these lines.

Second, there is a risk related to the unauthorized practice of medicine or scope of practice violations.  For physician assistants and other mid-level providers, services rendered outside of a supervising physician’s delegated scope of practice can constitute a scope violation—regardless of how the service is marketed.  Coaching offered by a licensed PA that crosses into clinical assessment or treatment could expose both the PA and the supervising physician to professional discipline.

(3) Ideas for Maintaining the Distinction in Practice

Practices that still choose to offer both services should consider implementing the following:

• Separate consent forms. Patients receiving clinical services should sign a therapy or clinical services consent that identifies the provider’s license and the nature of the licensed service. Coaching clients should sign a separate coaching consent that explicitly states: (a) the coaching relationship is not a clinical or therapeutic relationship; (b) no provider-patient relationship is formed; and (c) the coaching relationship will not become a clinical one.  A single combined form invites confusion.
• Separate documentation and records. Coaching should be documented separately and should not use clinical terminology—such as “diagnosis,” “treatment,” or “symptom”—in coaching notes.
• Clear intake and marketing language. The practice’s website, intake materials, and verbal communications should clearly describe which services are clinical and licensed and which are coaching. Referring to coaching as “mental health coaching” or presenting it alongside clinical services without clear differentiation can create the appearance that it is a clinical service.
• Do not allow the relationship to morph. If a coaching client begins presenting with mental health symptoms or requesting clinical guidance, a response to consider is to refer the client to a licensed provider—not to address the concerns within the coaching relationship. Coaching consent forms should address this scenario explicitly.
• Billing and financial agreements. Coaching services are not clinical services and are not covered by insurance. The practice’s financial agreements should reflect this clearly.  Submitting coaching sessions to insurance as if they were clinical services could implicate federal and state fraud and abuse statutes.

The coaching-therapy distinction is not a technicality—it is a structural compliance requirement for any practice that offers both types of services.  Getting the documentation right at the outset is far less costly than addressing a licensing complaint or a billing audit later.

If you would like to discuss practice structuring, scope of practice questions, or coaching-therapy distinctions for your mental health practice, or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com.  You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Disclaimers: Thoughts shared here do not constitute legal advice nor do they form an attorney-client relationship.  All digital presentations by our firm or its attorneys are provided as a public informational resource.  Although intended to be correct and up to date as of the date posted, we cannot guarantee the accuracy of posted information, especially as it relates to individual situations.  We do not routinely update such information.  To determine up-to-date information about the subject matter of this information and proper application to a specific situation, it is important that you consult your healthcare attorney.  Our communications of information through the Internet shall not constitute “presence,” “doing business” or the practice of law in any location, even when a specific state or its laws/rules are referenced.  Our firm maintains offices in Georgia and no other state.  Our attorneys are licensed in some, but not all, states.  For each client engagement we accept, our firm undertakes best efforts to ensure we are aware of and adhere to applicable jurisdictional requirements, which may include reviewing local rules, conducting relevant research and collaborating with, or referring a matter to, a local attorney.

(1) The No Surprises Act Has Multiple Components

The No Surprises Act was enacted as part of the Consolidated Appropriations Act of 2021 and created a suite of consumer protections against unexpected medical bills.  It is important to understand that not all of those protections apply to the same entities.  Some provisions—particularly those addressing surprise billing for emergency services and certain non-emergency services—are tied specifically to “health care facilities,” a defined term that encompasses hospitals, hospital outpatient departments, critical access hospitals, and ambulatory surgical centers.  Those facility-specific provisions are primarily designed for the insured-patient context, where a patient receives care at an in-network facility but is unknowingly treated by an out-of-network provider.  A cash-only outpatient clinic or telemedicine practice is unlikely to fall within those facility-specific provisions.

The GFE requirement, however, is different.  It is codified at Section 2799B-6 of the Public Health Service Act and implemented through 45 C.F.R. § 149.610.  The statutory text imposes the GFE obligation on “health care providers” and “health care facilities”—but the operative language of the GFE requirement, and the implementing regulations, appear to attach primarily to licensed providers rather than to facility status.  This distinction matters for practices that are not enumerated facilities but whose clinicians hold professional licenses.

(2) The GFE Requirement Arguably Follows the Provider’s License, Not Facility Status

Under the implementing regulations at 45 C.F.R. § 149.610, the GFE obligation applies to “convening providers” and “convening facilities”—terms defined to include any provider or facility that schedules a service or receives a request for a GFE.  A “convening provider” is defined broadly as a health care provider who schedules an item or service for an individual.  Because the definition references the provider’s status as a licensed health care provider—rather than whether the provider operates within an enumerated facility type—the GFE requirement appears to apply to any licensed clinician who schedules services for self-pay or uninsured patients.

The precise reach of the GFE requirement to every practice setting has not been conclusively resolved, and the regulatory framework has continued to evolve since the Act’s enactment.  Practices should consult with a healthcare attorney to evaluate their specific facts.  Because the No Surprises Act is predominantly structured around the insured-patient context and surprise billing in network-based care, there is a reasonable statutory interpretation question about whether the GFE obligation was intended to reach providers who have no relationship with any insurer or government payer and transact entirely in cash. CMS’s implementing guidance does not draw that distinction, however, and until the question is resolved through rulemaking or litigation, licensed providers scheduling services for self-pay patients should treat the GFE requirement as applicable.  That said, the CMS guidance on the GFE requirement is framed broadly and addresses independent practitioners, group practices, and other provider settings without limiting the obligation to hospital-based or enumerated facility providers.  The safer and more defensible compliance position for any licensed provider—including a solo or small-group telemedicine practice—is likely to treat the GFE requirement as applicable, but we recommend discussing your specific practice and services with your healthcare counsel.

(3) What Happens If the Actual Bill Exceeds the Estimate?

If a patient is billed an amount that exceeds the GFE by $400.00 or more, the patient has the right to initiate a patient-provider dispute resolution process administered through CMS.  A certified dispute resolution entity reviews the charges and can determine the appropriate payment amount.  The $400.00 threshold is not a buffer or safe harbor—it is the trigger for the dispute process, which can result in the provider being required to accept a lower payment.  Providers should treat the GFE as a meaningful commitment and keep their fee schedules current and documented.

(4) Practical Compliance Steps for Cash-Only and Telemedicine Practices

For a cash-only or telemedicine practice whose clinicians hold professional licenses, GFE compliance generally requires the following:

• Establish and document a current fee schedule for all services offered, identified by CPT or HCPCS code where applicable.
• Create a GFE form or workflow that captures the patient’s name, date of birth, date of estimate, the scheduled service, anticipated diagnosis or reason for visit, and estimated cost of care for the period ahead.
• Provide the written GFE to the patient automatically—without waiting for the patient to request it—within the timeframe required: at least one business day before the appointment if scheduled three or more days in advance, or at least three business days before the appointment if scheduled ten or more days in advance.
• Retain a copy of each GFE provided, as CMS may request documentation of compliance.
• Update the GFE promptly if the expected services or charges change materially before the scheduled appointment.

CMS has published guidance and model GFE forms that practices may use as a starting point.  Cash-only and telemedicine practices that do not yet have a GFE process in place should treat this as a priority compliance item, particularly given that the obligation runs with the provider’s license and attaches to every scheduled self-pay encounter.  If you would like to discuss No Surprises Act compliance or GFE requirements for your practice, or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com.  You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Disclaimers: Thoughts shared here do not constitute legal advice nor do they form an attorney-client relationship.  All digital presentations by our firm or its attorneys are provided as a public informational resource.  Although intended to be correct and up to date as of the date posted, we cannot guarantee the accuracy of posted information, especially as it relates to individual situations.  We do not routinely update such information.  To determine up-to-date information about the subject matter of this information and proper application to a specific situation, it is important that you consult your healthcare attorney.  Our communications of information through the Internet shall not constitute “presence,” “doing business” or the practice of law in any location, even when a specific state or its laws/rules are referenced.  Our firm maintains offices in Georgia and no other state.  Our attorneys are licensed in some, but not all, states.  For each client engagement we accept, our firm undertakes best efforts to ensure we are aware of and adhere to applicable jurisdictional requirements, which may include reviewing local rules, conducting relevant research and collaborating with, or referring a matter to, a local attorney.