Practicing from abroad legalities

[Psychresy]

I understand the rules regarding billing CMS and being located outside the US. What I'm wondering is, can a US physician practice abroad and see patients in the US WITHOUT needing a medical license in the country they are physically located in? I imagine different countries have different laws, but does anyone know of at least some countries where a US physician could base themselves and see insurance based patients back in the US (in the state the physician is licensed in)?

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[annoyedpsychiatrist]

Seems very unlikely, not even just from a license/insurance from perspective, have you considered malpractice insurance? How would that work out? Also time zone differences..the logistics seem like a nightmare. Sometimes the medications are even spelled differently in other countries so even simple things like ordering meds could be a challenge. I wonder how the EMR would work for that

 

[G Sheb]

The question about needing a medical license in the country you're practicing from is a very good one. I think it would be better to have it and cover your grounds, though I do not think the people who do it actually have licenses in these countries. Basically ask the medical board of the country you're planning to move into and have that documented. PP especially is appealing. The chance of the local authorities chasing you on that one is fairly low as long as you're not seeing local patients or doing something grossly illegal.

I know quite a few people who have setup like these and financially it makes a lot of sense. Legally I believe it's still a grey area, so my inclination is to be very careful about what you're doing. You really want to make sure you cover yourself as much as you could.

 

[Psychresy]

The question about needing a medical license in the country you're practicing from is a very good one. I think it would be better to have it and cover your grounds, though I do not think the people who do it actually have licenses in these countries. Basically ask the medical board of the country you're planning to move into and have that documented. PP especially is appealing. The chance of the local authorities chasing you on that one is fairly low as long as you're not seeing local patients or doing something grossly illegal.

I know quite a few people who have setup like these and financially it makes a lot of sense. Legally I believe it's still a grey area, so my inclination is to be very careful about what you're doing. You really want to make sure you cover yourself as much as you could.

This is my thought. I currently work for an outpatient clinic moonlighting. I could very easily pick up my laptop, move to say, Vietnam, and see patients. Yes the hours would be difficult, but I could make it work a few nights a week. From the American medical bodies, I don't see how I would be in trouble as I have a license where the patient is located. I would have to worry about the Vietnamese authorities, I guess in theory. But I'm not super concerned about that. I would imagine the EMR I am using now would work just fine on a VPN from abroad.

 

[bGMx]

Just wait for the block chain to catch up to medicine. You'll get your decentralized license and be a legitimate doctor without borders. I am not joking. Bitcoin existing in the first place is a less likely scenario, and yet, here we are.

 

[hamstergang]

Sometimes the medications are even spelled differently in other countries so even simple things like ordering meds could be a challenge. I wonder how the EMR would work for that

These two areas are not actually concerns. You would just get an EMR like you have here in the US and you'd order the same medications to the same pharmacies spelled the same way. Nothing from how you do your work would really feel like you're practicing in a different country.

 

[annoyedpsychiatrist]

These two areas are not actually concerns. You would just get an EMR like you have here in the US and you'd order the same medications to the same pharmacies spelled the same way. Nothing from how you do your work would really feel like you're practicing in a different country.

I read this completely backwards, the original post. For some reason I thought he was talking about physically being located in the USA and then seeing patients that are located in various countries. So yeah thats why I was confused, lol.

 

[ObsequiousAplomb]

Just wait for the block chain to catch up to medicine. You'll get your decentralized license and be a legitimate doctor without borders. I am not joking. Bitcoin existing in the first place is a less likely scenario, and yet, here we are.

You're really not joking? I don't understand how the block chain would in any way shape or form mean a license would be decentralized.

 

[PsyDr]

The license issue is just a small portion of the problem. All EU countries are subject to strict data security laws, which likely precludes telemedicine from non-EU countries. Other countries likely have similar issues, but IDK. Then there are issues of hospitalization, work visas, time zone, reliability of ISPs, etc. I would imagine any malpractice suit would be a slam dunk.

 

[bGMx]

If you're interested you could check out some of the work being done with block chain and organizations. Theoretically block chain could represent nation-states that are geographically unbounded and suddenly some of the issues you wrote are now no longer issues. Just takes a bit more ingenuity and future minded folks to figure out a system that would make sense and be safe.

 

[Merovinge]

The license issue is just a small portion of the problem. All EU countries are subject to strict data security laws, which likely precludes telemedicine from non-EU countries. Other countries likely have similar issues, but IDK. Then there are issues of hospitalization, work visas, time zone, reliability of ISPs, etc. I would imagine any malpractice suit would be a slam dunk.

He's trying to digit nomad being a physician, very unlikely to target the EU for this. Many countries have better ISPs than most of the USA (for a fraction of the price), and I'm not sure how hospitalization is different for someone in Laos or California if the patient is in New York. If telepsych is acceptable practice, it really should not matter where the physician is located in presuming it's a professional office setup.

If I were young/single this actually sounds interesting. Central/south America would make time zones easier. Asia would be best for telepsych to an ED for night shifts (like Australian radiology groups for the night shifts), but then you run into all the laws/regulations that EDs entail. You could work part-time and live like a king or work full time and sock away a bunch of cash.

 

[PsyDr]

He's trying to digit nomad being a physician, very unlikely to target the EU for this. Many countries have better ISPs than most of the USA (for a fraction of the price), and I'm not sure how hospitalization is different for someone in Laos or California if the patient is in New York. If telepsych is acceptable practice, it really should not matter where the physician is located in presuming it's a professional office setup.

If I were young/single this actually sounds interesting. Central/south America would make time zones easier. Asia would be best for telepsych to an ED for night shifts (like Australian radiology groups for the night shifts), but then you run into all the laws/regulations that EDs entail. You could work part-time and live like a king or work full time and sock away a bunch of cash.

It's one way to go. I've clearly looked into the set up, and the associated problems.

But there are many telemedicine companies that lie to providers about the legalities, without intention of supporting any providers who run into trouble.

 

[yanks26dmb]

I've seen a lot of countries issuing digital nomad work visas since COVID. They want to draw digital nomads to their countries to spend their dollars. I don't see why this couldn't work for a physician.

So it wouldn't be a work visa problem. The question I have, is what I think OP also has, and that is are you allowed to practice medicine, servicing a patient in the United States, but be based in another country. That would be dependent on that particular countries laws. I have no idea what the answer to that is.

 

[Psychresy]

Right. So the following are certainties in my mind and not the issue.

1. Private US insurers will reimburse for any work done while I am abroad.
2. As mentioned, many countries now offer digital nomad visas which I could use to legally work in a particular country.

What remains unclear is, do I need to have a medical license in country X to practice in country X EVEN IF I'm not seeing residents of country X. I can't find an answer to this. That said, I'm not sure how country X would know I'm actually seeing patients back in the states.

 

[PsyDr]

Right. So the following are certainties in my mind and not the issue.

1. Private US insurers will reimburse for any work done while I am abroad.
2. As mentioned, many countries now offer digital nomad visas which I could use to legally work in a particular country.

What remains unclear is, do I need to have a medical license in country X to practice in country X EVEN IF I'm not seeing residents of country X. I can't find an answer to this. That said, I'm not sure how country X would know I'm actually seeing patients back in the states.

You can't find the answer, because you're asking an impossibly broad question. Your question is like asking "Do I need to drive on the right side of the road in X country?". Each country has their own laws. Some countries share similar legal procedures, case law, or economic agreements with other countries. Some don't.

You have to define the specific target country, find a local attorney, and ask. Or you can just roll the dice, hope for the best, pray you're not told to leave the country without moving your own goods, or have your assets seized like a Panamanian bank account.

 

[Psychresy]

You can't find the answer, because you're asking an impossibly broad question. Your question is like asking "Do I need to drive on the right side of the road in X country?". Each country has their own laws. Some countries share similar legal procedures, case law, or economic agreements with other countries. Some don't.

You have to define the specific target country, find a local attorney, and ask. Or you can just roll the dice, hope for the best, pray you're not told to leave the country without moving your own goods, or have your assets seized like a Panamanian bank account.

Well, I've specifically looked in like 10 different countries. Can't find an answer. I think rolling the dice is not a bad option, particularly if my money stays in US accounts.

 

[G Sheb]

The license issue is just a small portion of the problem. All EU countries are subject to strict data security laws, which likely precludes telemedicine from non-EU countries. Other countries likely have similar issues, but IDK. Then there are issues of hospitalization, work visas, time zone, reliability of ISPs, etc. I would imagine any malpractice suit would be a slam dunk.

I know several people who see US patients from EU countries.
Where do you get that information "strict data security laws" precludes telemedicine from non-EU countries?

 

[PsyDr]

Well, I've specifically looked in like 10 different countries. Can't find an answer. I think rolling the dice is not a bad option, particularly if my money stays in US accounts.

I know several people who see US patients from EU countries.
Where do you get that information "strict data security laws" precludes telemedicine from non-EU countries?

I’ve paid EU and South American based attorneys many thousands of dollars for that information. I’m inclined to take their reasoned professional advice over “several people” you know.

You seem to know what you want to do and how you want to do that. It’s not how I’ve chosen to do it.

 

[G Sheb]

I’ve paid EU and South American based attorneys many thousands of dollars for that information. I’m inclined to take their reasoned professional advice over “several people” you

Was just curious if you had any verifiable source of information to support that claim.
Seems not.

 

[PsyDr]

Was just curious if you had any verifiable source of information to support that claim.
Seems not.

I do. You’re welcome to pay an attorney for the same information. But you’re trying to go the cheap route and bait me into giving away expensive information for free. Nice try, cheapo.

 

[surfguy84]

I do. You’re welcome to pay an attorney for the same information. But you’re trying to go the cheap route and bait me into giving away expensive information for free. Nice try, cheapo.

What's the consequence to you by helping someone else out with information? Just seems like a nice thing to do.

 

[PsyDr]

What's the consequence to you by helping someone else out with information? Just seems like a nice thing to do.

Same consequence as you paying an attorney for a consultation, and then telling me the information.

 

[surfguy84]

Same consequence as you paying an attorney for a consultation, and then telling me the information.

I'd be totally happy to share information if I had something you needed.

 

[PsyDr]

I'd be totally happy to share information if I had something you needed.

That’s super cool of you. When you go see an international attorney, or tax attorney, or have access to information that costs you $800/hr, let me know. I have a ton of questions, especially if it’s costing me $0.00/hr. Otherwise, I’ll help people to a reasonable degree. Because boundaries mean I don’t pay for other peoples benefit.

 

[forchinet121]

That’s super cool of you. When you go see an international attorney, or tax attorney, or have access to information that costs you $800/hr, let me know. I have a ton of questions, especially if it’s costing me $0.00/hr. Otherwise, I’ll help people to a reasonable degree. Because boundaries mean I don’t pay for other peoples benefit.

If you don’t want to share information, why are you even on this website? This is a site to share and discuss information…

 

[clozareal]

I wonder more so about taxes. Don't you have to pay taxes from where you are physically are located, especially if you have a residence there?

 

[Psychresy]

That’s super cool of you. When you go see an international attorney, or tax attorney, or have access to information that costs you $800/hr, let me know. I have a ton of questions, especially if it’s costing me $0.00/hr. Otherwise, I’ll help people to a reasonable degree. Because boundaries mean I don’t pay for other peoples benefit.

Ive consulted a tax atty when setting up my s Corp. I paid for this. If you've got specific questions, holler at me..I'll see if I can help.

 

[forchinet121]

I wonder more so about taxes. Don't you have to pay taxes from where you are physically are located, especially if you have a residence there?

I don’t think so..you have to pay where you’re working so if the clinic is in New York you have New York taxes…otherwise you can sit in the Cayman Islands paying 0 percent tax while working in New York..wouldn’t make sense

 

[G Sheb]

I wonder more so about taxes. Don't you have to pay taxes from where you are physically are located, especially if you have a residence there?

I don’t think so..you have to pay where you’re working so if the clinic is in New York you have New York taxes…otherwise you can sit in the Cayman Islands paying 0 percent tax while working in New York..wouldn’t make sense

No you pay taxes where you are a resident.
The US however is the one of the very few (I think the only one) countries that taxes expatriates.
So yes if you’re a US citizen you’d have to pay federal taxes even if you live outside.
However most countries have tax treaties with the US so you’re never double taxed.
In most cases you come out winning as opposed to living in the US. Some countries also give tax advantages for foreign residents to encourage digital nomads. Portugal had one such option though don’t know if they recently scrapped it.

 

[forchinet121]

No you pay taxes where you are a resident.
The US however is the one of the very few (I think the only one) countries that taxes expatriates.
So yes if you’re a US citizen you’d have to pay federal taxes even if you live outside.
However most countries have tax treaties with the US so you’re never double taxed.
In most cases you come out winning as opposed to living in the US. Some countries also give tax advantages for foreign residents to encourage digital nomads. Portugal had one such option though don’t know if they recently scrapped it.

So I’m a resident of texas but telepsych work in California, I have 0 percent state tax because I reside in texas?

 

[G Sheb]

So I’m a resident of texas but telepsych work in California, I have 0 percent state tax because I reside in texas?

That’s very different.
I’m not talking within the US. But if you live in another country.
States in the US have their own regulations and inter-state treaties.

 

[WisNeuro]

So I’m a resident of texas but telepsych work in California, I have 0 percent state tax because I reside in texas?

Depends on reciprocity agreements. Particularly in healthcare provision as where the patient is where the billing takes place.