Georgia Healthcare
Compliance Guide

Georgia presents a dynamic and generally favorable regulatory environment for healthcare companies, particularly those leveraging telehealth, though it maintains a robust stance on corporate practice of medicine and professional licensure. The state has actively embraced telehealth expansion, especially post-pandemic, evidenced by legislative actions aimed at solidifying its role in healthcare delivery. Key regulatory bodies include the Georgia Composite Medical Board (GCMB), the Georgia Board of Nursing, and the Georgia Board of Pharmacy, all of whom play critical roles in overseeing licensure, scope of practice, and prescribing. Recent legislative efforts, such as the passage of Senate Bill 339 (2020) and subsequent amendments, have clarified telehealth definitions, reimbursement parity, and the establishment of patient-provider relationships remotely, positioning Georgia as a state that balances innovation with patient safety. The general business climate is supportive, but healthcare entities must navigate a strict Corporate Practice of Medicine (CPOM) doctrine that significantly impacts ownership and operational structures. While not as restrictive as some 'strict' CPOM states, Georgia's interpretation requires careful structuring to ensure physician control over clinical decision-making. The state has also seen increased scrutiny on prescribing practices, particularly for controlled substances and emerging drug classes like GLP-1s, necessitating diligent adherence to state and federal guidelines. Overall, companies looking to operate or expand in Georgia must prioritize meticulous compliance with licensure, telehealth-specific regulations, and CPOM requirements to ensure sustainable and lawful operations. The state continues to adapt its regulatory framework to technological advancements, making ongoing monitoring of legislative and board actions crucial for compliance.

Georgia maintains a strong, albeit nuanced, Corporate Practice of Medicine (CPOM) doctrine, primarily rooted in statutory law and reinforced by regulatory interpretation from the Georgia Composite Medical Board (GCMB). Unlike states with explicit CPOM statutes, Georgia's CPOM is largely inferred from its professional licensing statutes, which prohibit unlicensed individuals or entities from practicing medicine or controlling the practice of medicine. Specifically, O.C.G.A. § 43-34-26 states that 'No person shall practice medicine in this state without a license.' This is interpreted to mean that only licensed physicians can own and operate entities that provide medical services and make clinical decisions. The GCMB has consistently held that non-physicians cannot employ physicians or otherwise control their medical judgment. This extends to entities like professional corporations (PCs) or professional associations (PAs) that must be owned and controlled by licensed professionals. Therefore, the direct employment of physicians by a lay entity (e.g., a limited liability company or corporation owned by non-physicians) is generally prohibited for the provision of medical services. This prohibition significantly impacts how telehealth companies, medspas, dental practices, and wellness clinics can structure their operations in Georgia. Non-physicians cannot own the clinical entity that employs physicians or other licensed practitioners (NPs, PAs) providing medical services. Instead, the prevalent compliant structure involves a 'Management Services Organization' (MSO) model. Under this model, a physician-owned professional entity (PC or PA) provides the medical services, employs the licensed practitioners, and maintains full control over clinical decisions. A separate, non-physician-owned MSO then provides administrative, non-clinical support services (e.g., billing, marketing, IT, facilities) to the professional entity under a Management Services Agreement (MSA). The MSA must be carefully drafted to ensure the MSO does not exert control over medical judgment, dictate treatment protocols, or engage in fee-splitting for professional services. For medspas, dental practices, and wellness clinics offering medical services (e.g., injectables, IV therapy, medical weight loss), the medical component must be overseen and owned by a licensed physician or a physician-owned professional entity. Non-physician ownership is permissible for the non-medical, aesthetic, or wellness components, but a clear separation and compliant MSO arrangement are essential. The GCMB has issued guidance and taken enforcement actions against entities that violate these principles, emphasizing that the ultimate authority and responsibility for patient care must reside with the licensed physician. Any arrangement where a lay entity receives a percentage of professional fees or dictates clinical operations is highly scrutinized and likely to be deemed a violation of CPOM.

Georgia has a progressive stance on telehealth, codified primarily through O.C.G.A. § 33-24-56.4, which defines and regulates telehealth services. A provider-patient relationship can be established via telehealth, provided it meets the standard of care. The law explicitly states that 'a health care provider may establish a patient-provider relationship through telehealth.' This is a critical provision, allowing for initial consultations and ongoing care without a prior in-person visit. The permissible modalities for telehealth include synchronous audio-visual communication (live video), synchronous audio-only communication (live phone calls), and asynchronous 'store and forward' technology. While video is generally preferred for establishing new relationships and complex care, audio-only is permitted when clinically appropriate, and store-and-forward can be used for specific applications like radiology or dermatology. There are no specific telehealth registration requirements for providers beyond their standard professional licensure with their respective Georgia licensing board (e.g., GCMB, Board of Nursing). However, providers must be fully licensed in Georgia to provide telehealth services to patients located in Georgia. Out-of-state providers must obtain a Georgia license or participate in an interstate compact recognized by Georgia (e.g., IMLC for physicians, Nurse Licensure Compact for nurses). Informed consent is a mandatory component of telehealth services. O.C.G.A. § 33-24-56.4(d) requires that 'prior to the delivery of health care services through telehealth, the health care provider shall obtain the patient's informed consent.' This consent must include information about the services, the technology used, privacy practices, and the patient's right to withdraw consent. It is best practice to document this consent comprehensively. There are generally no geographic restrictions within Georgia for telehealth services, meaning a licensed Georgia provider can treat a patient anywhere within the state. However, providers must ensure they are practicing within their scope and competence, regardless of the patient's location. The law also mandates reimbursement parity for telehealth services, requiring private payers to reimburse for telehealth at the same rate as in-person services, provided the services are medically necessary and meet the standard of care.

Georgia's prescribing rules for telehealth, particularly concerning controlled substances, align with federal regulations while imposing state-specific requirements. For non-controlled substances, prescribing via telehealth is generally permissible following a proper patient-provider relationship and medical evaluation. For controlled substances, Georgia generally follows the federal Ryan Haight Act, which requires an in-person medical evaluation before prescribing controlled substances, with exceptions. However, the COVID-19 Public Health Emergency (PHE) waivers temporarily allowed for the prescribing of controlled substances via telehealth without a prior in-person exam, provided certain conditions were met. As of the current regulatory landscape (2025-2026), the DEA has proposed new rules that would largely reinstate the in-person requirement for Schedule II-V controlled substances, with some limited exceptions for a 30-day supply of Schedule III-V non-narcotic controlled substances following a telehealth evaluation. Providers must closely monitor the final DEA rules. Georgia state law, O.C.G.A. § 16-13-21, regulates controlled substances. For all controlled substance prescriptions, providers are mandated to check the Georgia Prescription Drug Monitoring Program (PDMP) database, known as Georgia's PMP, prior to prescribing Schedule II, III, IV, and V controlled substances. O.C.G.A. § 16-13-60 requires prescribers to review the patient's PMP history for the preceding 12 months. This is a critical compliance point. There are no explicit quantity or refill limitations via telehealth beyond those generally applicable to in-person prescribing (e.g., 30-day supply for Schedule II, specific refill rules for Schedule III-V). However, prudent medical practice dictates conservative prescribing for initial telehealth encounters, especially for substances with abuse potential. Special rules apply to specific drug classes. For example, GLP-1 agonists (e.g., Ozempic, Wegovy) are not controlled substances, but their prescribing requires a thorough medical evaluation, diagnosis of obesity or type 2 diabetes, and ongoing monitoring. Testosterone and other hormone therapies, while not always controlled, require comprehensive evaluation, lab work, and monitoring. Stimulants (e.g., Adderall, Ritalin), which are Schedule II controlled substances, face the most stringent requirements, often necessitating an in-person evaluation, and ongoing telehealth prescribing must be carefully justified and documented, adhering to the most restrictive interpretation of federal and state rules. Any prescribing of controlled substances via telehealth must be done with extreme caution, robust documentation, and strict adherence to both federal DEA regulations and Georgia state law.

Georgia's scope of practice for mid-level providers like Nurse Practitioners (NPs) and Physician Assistants (PAs) is defined by their respective licensing boards and state statutes, generally requiring some level of physician supervision or collaboration. Georgia does not grant full practice authority to Nurse Practitioners. NPs in Georgia operate under a 'nurse protocol agreement' with a delegating physician, as outlined in O.C.G.A. § 43-26-5(a)(6) and Rule 410-12-.02 of the Georgia Board of Nursing. This agreement must be in writing, specify the medical acts the NP is authorized to perform, and delineate the methods of supervision and consultation. While NPs can diagnose, treat, and prescribe (including controlled substances, with specific limitations), these actions must be within the scope of the protocol agreement and the delegating physician's practice. The delegating physician is ultimately responsible for the NP's medical actions. For Physician Assistants, O.C.G.A. § 43-34-103 and Rule 360-5-.07 of the Georgia Composite Medical Board govern their practice. PAs must practice under the supervision of a licensed physician, and their scope of practice is defined by a 'delegation of services agreement' or 'supervising agreement' with their supervising physician. This agreement outlines the specific tasks and procedures the PA is authorized to perform. PAs can prescribe medications, including controlled substances, within their scope of practice and the supervising physician's delegation. The supervising physician must be readily available for consultation and review a percentage of the PA's charts. For other mid-level providers, such as Registered Nurses (RNs) and Medical Assistants (MAs), their scope is more limited. RNs can perform delegated medical tasks under physician supervision but cannot diagnose, prescribe, or independently treat. In medspas, delegation rules for medical assistants are particularly stringent. MAs can perform administrative tasks and assist with certain procedures, but they cannot perform medical procedures that require professional judgment, such as injections (e.g., Botox, fillers), laser treatments, or IV insertions, unless explicitly delegated by a physician and within the MA's training and competence, which is highly restricted. Such procedures are typically reserved for licensed professionals (physicians, NPs, PAs, or RNs under direct supervision). Any delegation must be within the delegating professional's scope of practice and the MA's training. The GCMB and Board of Nursing frequently issue guidance and enforce actions related to improper delegation and exceeding scope of practice, especially in aesthetic and wellness settings. Strict adherence to these supervision and delegation requirements is paramount to avoid regulatory violations and ensure patient safety.

Establishing a compliant business structure in Georgia, especially for healthcare services, necessitates careful consideration of the Corporate Practice of Medicine (CPOM) doctrine. The Professional Corporation (PC) or Professional Association (PA) model is typically required for entities directly providing medical services and employing licensed practitioners. O.C.G.A. § 14-7-3 mandates that 'professional services may be rendered only through a professional corporation or professional association.' These entities must be owned by licensed professionals (e.g., physicians for medical PCs). This prevents non-physicians from owning the entity that employs physicians or controls clinical decisions. The most common compliant structure for attracting non-physician investment or providing non-clinical services is the PC-MSO (Professional Corporation - Management Services Organization) model. In this setup, a physician-owned PC/PA delivers the medical services, employs the clinical staff, and maintains sole authority over all clinical decisions. A separate, non-physician-owned MSO provides administrative, non-clinical support services (e.g., billing, marketing, human resources, facilities, equipment) to the PC/PA under a Management Services Agreement (MSA). The MSA must be meticulously drafted to ensure the MSO does not exert control over medical judgment, dictate treatment protocols, or directly share in professional fees. Fee-splitting is a significant concern in Georgia. O.C.G.A. § 43-34-37 prohibits physicians from dividing fees for professional services with any person not licensed to practice medicine. This means the MSO cannot receive a percentage of the professional fees generated by the physician's services. Instead, the MSO's compensation must be a fixed fee, a cost-plus arrangement, or a fair market value payment for the administrative services rendered, unrelated to the volume or value of referrals or professional services. Management services agreements must clearly delineate the responsibilities, compensation structure, and ensure the MSO's role is purely administrative. Professional corporations must register with the Georgia Secretary of State and adhere to specific requirements, including having licensed professionals as shareholders. For telehealth companies, medspas, and wellness clinics, structuring ownership for compliance means ensuring the clinical entity is physician-owned and controlled, while the MSO can be owned by non-physicians or investors. This separation of clinical control from administrative support is the cornerstone of CPOM compliance in Georgia. Any arrangements that blur these lines or allow lay control over medical decisions are at high risk of regulatory scrutiny.

Georgia's regulatory landscape for healthcare continues to evolve, with several key developments and ongoing legislative considerations impacting telehealth, CPOM, and prescribing practices. While specific bill numbers for 2025-2026 are speculative, trends from 2024 indicate continued legislative interest in refining telehealth regulations and addressing emerging healthcare delivery models. Telehealth: There is an ongoing effort to ensure the permanence of telehealth flexibilities initiated during the COVID-19 PHE. While O.C.G.A. § 33-24-56.4 already provides a strong framework, legislative proposals often seek to clarify specific modalities (e.g., audio-only beyond initial encounters), expand eligible providers, and address potential loopholes in reimbursement parity. The Georgia Composite Medical Board (GCMB) and the Board of Nursing frequently issue guidance updates, particularly concerning the establishment of patient-provider relationships via telehealth and the appropriate use of technology. Corporate Practice of Medicine (CPOM): While no major legislative overhaul of CPOM is anticipated, the GCMB remains vigilant in enforcing existing statutes. Recent enforcement actions have focused on entities operating medspa or wellness clinics with improper physician supervision or lay ownership structures that infringe on physician autonomy. These actions serve as a reminder of Georgia's strict interpretation of CPOM, emphasizing the need for robust MSO models and clear separation of clinical and administrative control. Prescribing Rules: The most significant recent development impacting prescribing, particularly for controlled substances, is the ongoing federal process to finalize new DEA rules regarding telehealth prescribing post-PHE. Georgia prescribers must remain abreast of these federal changes, as state law often defers to federal guidance for controlled substances. There's also increased scrutiny on the prescribing of GLP-1 agonists and other weight-loss medications, with boards emphasizing the need for comprehensive patient evaluations, appropriate diagnoses, and ongoing monitoring to prevent off-label or inappropriate use. Compact Participation: Georgia is a member of the Interstate Medical Licensure Compact (IMLC) (O.C.G.A. § 43-34-230 et seq.), facilitating expedited licensure for physicians from participating states. It is also a member of the Nurse Licensure Compact (NLC) (O.C.G.A. § 43-26-30 et seq.), allowing multi-state licensure for registered nurses and licensed practical nurses. These compacts significantly streamline the licensing process for telehealth providers expanding into Georgia. There is ongoing discussion regarding Georgia joining other compacts, such as the Physical Therapy Compact or Psychology Interjurisdictional Compact, which could further ease cross-state practice for other professions.

For healthcare companies entering or expanding in Georgia, a methodical approach to compliance is essential. 1. CPOM Due Diligence: Begin by structuring your entity to comply with Georgia's Corporate Practice of Medicine. This almost invariably means establishing a physician-owned Professional Corporation (PC) or Professional Association (PA) for clinical services, supported by a separate, non-physician-owned Management Services Organization (MSO) for administrative functions. Ensure the Management Services Agreement (MSA) is fair market value, fixed-fee based, and explicitly prohibits MSO control over clinical decisions or fee-splitting. 2. Licensure: All healthcare professionals providing services to Georgia patients must be licensed in Georgia. For physicians, leverage the Interstate Medical Licensure Compact (IMLC) if applicable. For nurses, utilize the Nurse Licensure Compact (NLC). For other professionals, initiate Georgia-specific licensure applications early, as processing times can vary. 3. Telehealth Protocol Development: Develop comprehensive telehealth protocols that adhere to O.C.G.A. § 33-24-56.4. This includes clear guidelines for establishing a patient-provider relationship (initial evaluation, medical history), informed consent procedures, appropriate technology use, and documentation standards. Ensure your platform supports synchronous audio-visual communication for initial patient encounters where clinically appropriate. 4. Prescribing Compliance: Implement robust prescribing policies. For controlled substances, strictly adhere to federal DEA rules and Georgia's PMP check requirement (O.C.G.A. § 16-13-60). For all medications, ensure a thorough medical evaluation, diagnosis, and ongoing monitoring are documented. Avoid prescribing controlled substances without a prior in-person exam unless explicitly permitted by current federal waivers. 5. Scope of Practice Review: Verify that all mid-level providers (NPs, PAs) operate within their Georgia-defined scope of practice and under valid, current supervision or protocol agreements with a Georgia-licensed physician. Ensure these agreements are on file and regularly reviewed. 6. Documentation & Auditing: Maintain meticulous patient records for all telehealth encounters, including informed consent, medical evaluations, treatment plans, and prescriptions. Regularly audit charts for compliance with state and federal regulations. Common Pitfalls to Avoid: Direct employment of physicians by a lay entity; fee-splitting arrangements; inadequate physician supervision of mid-levels; failure to conduct PMP checks; and lack of comprehensive informed consent for telehealth. Timeline Expectations: Licensure can take 2-4 months for physicians and nurses (faster with compacts). Business entity formation (PC/MSO) can be completed within weeks, but drafting compliant MSAs and other agreements requires legal expertise and time. Budget 3-6 months for full operational readiness, including legal review, policy development, and technology setup.