Learn how to avoid the most costly multi-state compliance mistakes and build the HR, payroll, and licensing infrastructure needed to scale your private practice safely and sustainably.
Episode 23
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Operating across multiple states multiplies your growth potential, and your compliance exposure. In this episode, Brandon Seigel identifies the most frequent and costly mistakes he sees multi-state practices make, and explains how to build the infrastructure to avoid them.
The most pervasive mistake Brandon encounters is treating all states as if they operate under the same rules. Federal employment law sets a floor, but states set their own ceilings, and some set them significantly higher. Minimum wage, overtime thresholds, paid leave mandates, non-compete enforceability, and termination procedures can vary dramatically from state to state. A policy that's perfectly compliant in one state can be a liability in another.
Payroll tax mismanagement is another frequent and expensive error. Many practices don't realize that employing someone in a new state creates a tax nexus in that state, meaning the practice may now owe state corporate income tax, franchise tax, or other state-level business taxes, in addition to payroll tax obligations. Overlooking this can result in back taxes, penalties, and interest that far exceed the cost of getting it right from the start.
Licensing and credentialing failures are particularly common among telehealth-forward practices. It's not enough for a clinician to be licensed in their home state, they must hold a valid license in every state where their patients are located at the time of service. Billing for services delivered by an unlicensed provider, even inadvertently , can result in payer audits, clawbacks, and license sanctions.
Brandon also highlights the cultural and management challenge of multi-state operations: remote teams in different states can develop disconnected cultures, inconsistent accountability standards, and communication breakdowns if leadership doesn't intentionally build structure around the distributed model. The HR infrastructure that works for a single-site practice rarely scales to multi-state without deliberate redesign.
The antidote to all of these risks is documentation and intentionality. Build state-specific compliance checklists. Audit your licensing and credentialing status for every provider in every state annually. Engage a payroll provider and HR consultant with multi-state expertise. And treat compliance not as a once-and-done project but as an ongoing operational responsibility, because the rules keep changing, and the stakes keep rising.
Key Takeaways
"The price of compliance is always less than the price of non-compliance." , Unknown
