Common Legal Pitfalls Texas Physicians Face When Involved with Med Spas

Physicians are subject to legal repercussions in the med spa setting, particularly if they are supervising, owning, or delegating within these practices. Because Texas has one of the more stringent regulatory frameworks in the country, physicians need to be especially careful to stay compliant with both the Texas Medical Practice Act and Texas Medical Board (TMB) rules. Below is an article on the legal pitfalls physicians may encounter when working with a med spa.

1. Improper Ownership and Corporate Practice of Medicine Violations

Texas strictly enforces the Corporate Practice of Medicine doctrine.

• Non-physicians (including corporations/LLCs) generally cannot employ physicians to provide medical services.

• Doctors can own, non-doctors can own, but they cannot own together.

Pitfalls Include:

• Allowing non-physician owners to influence medical decisions.

2. Insufficient Physician Supervision and Delegation

Texas law requires that medical procedures offered in med spas be performed or delegated properly and under appropriate physician oversight.

Issues Commonly Seen:

• Delegating medical procedures (e.g., Botox, dermal fillers, lasers) to staff without appropriate supervision or delegation protocols.

• Having a remote or minimally involved physician medical director (e.g., only visiting occasionally).

• Failing to maintain written standing delegation orders or supervision documentation.

3. Failure to Perform Required Good-Faith Examinations

Under Texas regulations, a good-faith examination by a physician or qualified mid-level provider (NP/PA) must be conducted and documented before initiating treatments. Skipping or improperly documenting this exam can lead to enforcement actions and malpractice liability.

4. Poor Medical Records, Consent, and Documentation

Documentation is not just a best practice. It is required.

Common issues include:

• Missing or incomplete treatment records.

• Lack of signed, procedure-specific informed consent forms.

• Inadequate documentation of physician oversight.

These mistakes increase exposure to TMB complaints, civil liability, or license sanctions.

5. Misleading Advertising and Marketing

Marketing that exaggerates results, misrepresents provider credentials, or fails to disclose paid endorsements can trigger violations of Texas Medical Board rules and federal advertising regulations. Claims like “guaranteed results” or implying a non-physician is a doctor are red flags.

6. Using Unqualified Staff to Perform Medical Procedures

• Estheticians and cosmetologists may perform non-surgical cosmetic services.

• Medical procedures done without proper licensure or oversight can constitute the unauthorized practice of medicine.

7. Fee-Splitting, Kickbacks, and Improper Billing

Physicians must avoid improper financial arrangements, such as:

• Fee-splitting with non-physicians for referrals or services.

• Inflated or fraudulent billing for treatments the provider did not personally oversee.

These practices can lead to civil or criminal penalties under both state and federal law.

8. Telemedicine and Remote Supervision Compliance

If a practice uses telehealth for evaluations or supervision, it must comply with specific Texas telemedicine rules, including proper technology and documentation. Failure to do so can invalidate treatment plans and lead to compliance issues.

9. Non-Compliance with New and Emerging Regulatory Requirements

Texas continues to evolve med spa regulation, such as requiring certain physician qualifications for cosmetic procedures and stricter delegation rules. Physicians need to stay current with changing laws.

10. Best Practices to Avoid These Pitfalls

To reduce legal risk, physicians involved with med spas should:

• Structure the business correctly from the start.

• Maintain active, documented supervision and delegation.

• Ensure proper examinations, consent, records, and billing practices.

• Regularly audit advertising and staff roles against Texas law.

• Stay updated on regulatory changes and medical board guidance.

Conclusion on Legal Pitfalls Texas Physicians Face When Involved with Med Spas

For Texas physicians, involvement in a med spa can present significant opportunity, but also significant regulatory exposure. The Texas Medical Board has made it clear that cosmetic medicine is still the practice of medicine, and it carries the same legal, ethical, and professional obligations as any other clinical setting. Missteps in ownership structure, delegation, supervision, documentation, advertising, or financial arrangements can quickly escalate from operational oversights to licensure threats or civil liability.

As regulatory scrutiny increases - particularly in light of recent legislative developments - physicians must take a proactive, compliance-first approach. That means structuring entities properly from the outset, maintaining meaningful oversight, documenting thoroughly, and regularly reviewing delegation and marketing practices. A med spa should never operate on autopilot under a “paper medical director.”

Ultimately, the safest and most sustainable med spa model in Texas is one grounded in active physician leadership, clear compliance protocols, and ongoing legal review. When physicians treat med spa services with the same diligence as any other medical practice, they not only reduce legal risk, but they strengthen patient safety and long-term business viability.

Feel free to reach out if you need more specific information or further clarification.

Weitz Morgan is a leading law firm in Texas in providing comprehensive advice and guidance to med spas and healthcare providers. With a deep understanding of the unique challenges and complexities faced by this rapidly growing industry, our team of experienced attorneys is dedicated to helping med spas and physicians navigate the legal landscape successfully.