Top 5 Med Spa Compliance Mistakes That Could Cost You Thousands — State by State Breakdown

Med spas are booming across the country — but so are compliance violations. From California to Texas, each state has its own laws on ownership, supervision, and scope of practice. If you think a “one-size-fits-all” approach will protect your license, think again. In this blog, we’ll break down 5 of the most costly compliance mistakes that could lead to board complaints, audits, and even clinic shutdowns — with examples of how state-specific laws make all the difference.

Mistake 1: Illegal Med Spa Ownership

Who can own a med spa? The answer changes depending on where you’re licensed.

California: Only licensed physicians (MDs or DOs) can own medical practices due to the Corporate Practice of Medicine (CPOM) doctrine. You can’t "rent" an MD to cover your business.

Texas: A med spa must be owned by a physician or by a legal entity wholly owned by physicians. However, RNs and NPs cannot own medical spas unless they partner via a Management Services Organization (MSO).

Florida: Non-physicians may co-own, but a licensed medical director must supervise all medical services.- New York: Strong CPOM enforcement. No unlicensed individuals may have control or profit-sharing from medical services.

💡 Solution: Always check if your state enforces CPOM and structure your MSO/legal entity accordingly.

Mistake 2: No Written Delegation Orders or Protocols

You can’t delegate tasks to nurses, estheticians, or MAs without signed, written delegation protocols.

Georgia: Delegation orders must be specific, signed by a physician, and define scope and supervision.

North Carolina: Standing orders must be renewed at least annually and signed by both the supervising physician and the nurse or PA.

Nevada: Delegation must follow the Board of Nursing and Medical Board rules — and estheticians can only perform specific tasks under medical direction.

🧾 Solution: Implement custom delegation orders reviewed annually for every staff role.

Mistake 3: Unqualified Providers Performing Good Faith Exams (GFEs)

Only MDs, DOs, NPs, or PAs can legally perform a Good Faith Exam — not RNs or estheticians.

Arizona: GFEs are required before any medical aesthetic treatment. RN-performed exams are non-compliant.

Illinois: A physician must review and approve the initial assessment even if delegated to a PA/NP.

Ohio: GFEs are required by law before any prescription-based treatment like Botox, fillers, or laser.

⚠️ Solution: Schedule GFEs with licensed prescribers and document everything.

Mistake 4: Inadequate or Outdated Informed Consents

State medical boards often investigate complaints that stem from lack of clear, specific consents.

Michigan: Requires that patients be informed of provider credentials and consent to any medical procedure.

Colorado: Consents must include risks, benefits, alternatives — and should be treatment-specific.

Pennsylvania: General waivers don’t protect providers from liability. You must outline treatment expectations clearly.

📝 Solution: Use procedure-specific consents that reflect your state’s informed consent rules.

Mistake 5: Poor Supervision Models & “Rent-a-Medical-Director” Setups

Many med spas get into trouble by contracting medical directors who don’t actually supervise — a huge red flag.

Virginia: The medical director must provide actual supervision and is responsible for all delegated acts.

Tennessee: RNs must have written supervision by a physician or APRN; you can’t list a name without real oversight.

Oregon: You cannot legally operate a med spa with a passive MD partner. The physician must be engaged in treatment protocols and staff training.

🚨 Solution: Structure legitimate supervisory relationships with ongoing documentation, chart reviews, and training logs.

Conclusion: Compliance Isn’t Optional — It’s Your Insurance

Each state has its own rules — and just one mistake can cost you thousands in legal fees, lost income, or even your license. Whether you’re opening your first med spa or scaling into multiple states, compliance is your best protection. At The Aesthetic Compliance Co., we specialize in creating state-specific protocols, custom delegation orders, and regulatory checklists to keep your practice protected.✅ Book your Compliance Audit with us today!

Christina Garcia

Founder