Telehealth Across the Potomac With a Lapsed Maryland License
Nadia Okafor, PT, DPT, lives in Arlington, Virginia, and holds active Virginia and DC licenses. She has held a Maryland license since 2016. In February her online renewal payment was declined, and the Board's notices went to a work email address she had stopped using; her Maryland license expired on March 31 and she did not notice. From April 1 through April 23 she completed 34 video visits with 11 patients, all of whom were sitting in their own homes in Montgomery County, Maryland: a post-ACL reconstruction series, two chronic neck pain cases, and a pelvic health patient. She documented in the clinic's cloud electronic record, and the clinic billed Maryland Medicare Part B and CareFirst for the visits. On April 24 the credentialing coordinator, who has just run a license verification, asks Okafor to 're-date the notes to March so the payers don't kick them back' while she sorts out the renewal, and points out that the health system contract requires every treating clinician to hold a current license in the state where the patient is located.
1. Was a Maryland license required for the April video visits? Explain the jurisdictional rule and why the Virginia and DC licenses do not resolve it.
Read the worked answer
Licensure follows the patient, not the clinician. Physical therapy delivered to a patient who is physically located in Maryland is the practice of physical therapy in Maryland, whether the visit is in person or by video, whether the clinician is paid, and whether the clinician ever crosses the state line. Okafor's Virginia and DC licenses authorize her to treat patients located in Virginia and DC; they say nothing about a patient sitting in Gaithersburg.
Telehealth does not create an exception. The Board's jurisdiction is triggered by where the patient is at the time of service, so a complaint about these visits would be evaluated under Maryland law even though Okafor never entered the state. The health system contract clause the coordinator cites is simply restating the same rule for commercial purposes.
A related trap: the pelvic health patient and the post-ACL patient present differently, but the jurisdictional analysis is identical for all eleven. The only Maryland-authorized provider in the equation would have been Okafor under a valid Maryland license, and from April 1 there was none.
2. What must Okafor do immediately, and how should she handle the 34 completed visits, the billing, and the request to re-date the notes?
Read the worked answer
First, stop. She should notify her employer in writing, with a date and time, that she is suspending all care for Maryland-located patients until the license is restored, and reassign or reschedule those patients to a Maryland-licensed clinician. Second, verify her status through the Board's license lookup and contact the Board about reinstatement - an expired Maryland license is not simply switched back on, and the Board may require a reinstatement application, fees, late fees, and evidence of continuing education. Third, keep a written chronology of the lapse and the corrective steps; prompt self-reporting is treated very differently from being discovered.
The re-dating request must be refused flatly. Re-dating or backdating notes converts a clerical lapse into falsification of a medical record and misrepresents the date a service was rendered to payers. Corollary rules: no creating notes now for visits already delivered as if they were contemporaneous, no editing the electronic audit trail, no altering the dates in the billing system.
On the 34 visits and the claims, the compliance officer or privacy officer should be brought in, because services rendered without a license are generally not billable and refunds or claim corrections may be required. That is a separate exposure from the licensure one, and it should be handled by people whose job it is.
3. Does the fact that the expiration was an accident change the analysis? Discuss how the Board is likely to view intent, notice, and the appropriate mitigation.
Read the worked answer
Intent is not the test for whether unlicensed practice occurred. The operative fact is that physical therapy was provided to Maryland patients while no Maryland license was in effect. The Board typically treats the conduct as having happened and then weighs intent, duration, notice, and remediation in setting the sanction.
Mitigating facts here: the lapse arose from a declined payment and a stale email address, not a decision to practice without a license; the therapist stopped as soon as she learned; there is no allegation of patient harm; and she self-reported. Aggravating facts: the lapse ran 23 days and 34 visits after the expiration, the clinic billed payers throughout, and licensees are responsible for maintaining a current address of record with the Board, so 'I never got the notice' explains the lapse but does not excuse it.
Likely outcomes span a reprimand with a civil penalty and conditions up through probation, depending on what the Board learns about the billing and the record-keeping. The re-dating request, if it had been carried out, would have pushed this from an administrative lapse into an integrity case and would predictably have produced a far harsher result.