Maryland Corporate Practice of Medicine Rules (2026 Guide)

Maryland enforces a corporate practice of medicine (CPOM) rule, but an odd one. No statute spells it out, and Maryland's highest court has never expressly adopted the doctrine. Instead, the rule lives in the physician licensing board's long-held position, the professional corporation laws, and Attorney General opinions. As of October 2026, we classify Maryland as moderate. A lay-owned business corporation should not plan to employ physicians directly, so a non-physician founder should use a friendly PC-MSO structure. Maryland's distinctive wrinkle is fee splitting: the Attorney General has said a percentage fee must reasonably reflect the value of the services behind it. NP founders have real room here. Maryland NPs practice independently, with a mentor requirement only for newly certified NPs. PAs now work under collaboration agreements rather than delegation.

This is general information, not legal advice. Confirm the current rules with a healthcare attorney licensed in Maryland. Last reviewed October 2026. State rules change often; statute and case references are summaries, not quotations.

Key takeaways

Maryland's CPOM rule rests mainly on the position of the Maryland Board of Physicians, which has long been described as barring corporations other than professional corporations, hospitals and HMOs from employing physicians to practice medicine.
A 2000 Maryland Attorney General opinion on physical therapy observed that Maryland's highest court has never explicitly embraced the corporate practice doctrine.
A 1998 Maryland Attorney General opinion read the physician fee-splitting provision to require that a percentage-based fee reasonably reflect the value of services actually provided.
Maryland nurse practitioners have practiced without a physician attestation since the Nurse Practitioner Full Practice Authority Act of 2015, though newly certified NPs must name a mentor for 18 months.
The Physician Assistant Modernization Act of 2024 moved Maryland PAs from delegation agreements to collaboration agreements.

Does Maryland have a corporate practice of medicine doctrine?

Yes in practice, unsettled in theory. That gap is what makes Maryland different.

The clearest statement of the doctrine is the licensing board's. Older Maryland summaries report that the Board (then called the Board of Physician Quality Assurance) took the position that a corporation may not employ a physician to practice medicine in Maryland unless it is a professional service corporation, a hospital or a health maintenance organization. That position has never been formally withdrawn as far as we found.

The courts are a different story. In 85 Op. Att'y Gen. 238 (2000), the Attorney General considered whether lay-owned businesses could provide physical therapy. The opinion acknowledged that most courts elsewhere bar corporations from employing physicians, but noted that Maryland's highest court had never explicitly embraced the judge-made doctrine. It concluded that a lay-owned business could own a physical therapy practice and contract with licensed therapists, though not as a professional corporation.

That opinion did not decide anything about physicians. It does explain why some national surveys label Maryland "unsettled." We keep the moderate label because the Board's position, the professional corporation rules and the fee-splitting provision all point the same direction, and because no Maryland authority we found approves direct lay employment of physicians.

The state has also noticed the gap. A 2025 Maryland Health Care Commission report on private equity in physician practices said enforcement of the doctrine has eroded over time and that MSO contract structures are used to work around it.

Who can own a medical practice in Maryland?

Physicians practice through a professional service corporation or another licensee-owned entity. Maryland's professional service corporation law limits a corporation to a single kind of professional service, so a medical PC is owned by physicians.

Maryland's LLC statute does not carry the same one-profession limit, which is why some multidisciplinary groups use it. Be careful with lay ownership, though. Maryland commentators have reported that both the Board and the Attorney General have suggested an LLC owned by non-licensees may not practice medicine.

The recognized exceptions are hospitals and HMOs, which may employ physicians.

Can nurse practitioners and physician assistants own a practice in Maryland?

Nurse practitioners. Maryland is a full practice authority state. The 2015 Full Practice Authority Act ended the requirement that NPs keep a physician attestation. Under COMAR 10.27.07.02, an applicant who has never been certified as an NP in any state must identify a mentor for 18 months. The mentor role is advisory, not supervisory. NPs certified elsewhere for long enough may not need one. Confirm against the Board of Nursing's current rules.

An NP can open an independent nursing practice. Whether an NP can hold equity in a medical professional corporation alongside physicians is a separate question under the one-profession rule. Get Maryland counsel on that before you set up a mixed entity.

Physician assistants. The Physician Assistant Modernization Act of 2024 took effect October 1, 2024. It replaced delegation agreements and supervising physicians with collaboration agreements and patient care team physicians. Per the Board's guidance, collaboration agreements are not submitted for approval, but the Board must be notified of the executed agreement before the PA practices. A PA still needs a collaborating physician, so a PA-founded clinic should plan for a collaborating physician from day one.

How does the friendly PC-MSO model work in Maryland?

The standard friendly PC-MSO model works: a Maryland-licensed physician owns the PC, and your company's MSO provides non-clinical services under a management services agreement. Clinical decisions stay with licensed providers.

The design question in Maryland is the fee. In 83 Op. Att'y Gen. 142 (1998), the Attorney General analyzed the physician fee-splitting provision in the Health Occupations Article. As summarized, the opinion said:

A percentage charge must reasonably reflect the value of the services provided, measured across patients in the aggregate.
Charging a percentage on a large group of patients who receive no services from the manager raises fee-splitting problems.
Selling a practice for a share of its future income can count as fee splitting, while a price based on an appraisal of historical revenue generally does not.

No fixed safe percentage exists. A flat or cost-plus fee tied to documented services is the more defensible design. If you use a percentage, tie it to services the MSO actually performs for those patients. Our management services agreement guide covers the drafting.

Watch the legislature too. The Commission's 2025 report noted that Maryland did not then require advance notice of physician practice transactions. A 2026 bill, HB 944, proposed review of "material change transactions," including MSO formation. Check whether it or a successor bill was enacted before you close a deal.

What does this mean for a telehealth brand serving Maryland patients?

CPOM follows the patient. If your clinicians treat people located in Maryland, Maryland's rules apply wherever your company is incorporated.

Maryland has no special out-of-state telehealth registration. Plan on full Maryland licenses for every physician, NP and PA who treats Maryland patients, and check whether a compact pathway can speed physician licensing. Our telehealth licensing by state guide compares the options.

A practical setup: a physician-owned Maryland PC, Maryland-licensed NPs (independent) and PAs (with collaboration agreements) inside it, and a flat-fee MSA. Neighboring guides: Virginia, Delaware, District of Columbia.

Maryland CPOM at a glance

Topic	Maryland (as of October 2026)
CPOM enforcement	Moderate: board position and entity rules; highest court has not expressly adopted the doctrine
Primary legal basis	Board of Physicians position; Attorney General opinions (1998, 2000); professional service corporation law
Professional entity options	Physician-owned professional service corporation; licensee-owned LLC (confirm with counsel)
Fee-splitting rule	Health Occupations Article; 1998 AG opinion says percentage fees must reasonably reflect services
NP practice authority	Full; 18-month mentor for newly certified NPs
Out-of-state telehealth licensing	No special registration; full Maryland license required
Typical structure for non-physician founders	Physician-owned PC plus lay-owned MSO under a flat-fee MSA

Frequently asked questions

Can a non-physician own a medical practice in Maryland?

Not directly. The Board of Physicians has long taken the position that only professional corporations, hospitals and HMOs may employ physicians. A non-physician can own the MSO that manages a physician-owned practice.

Is Maryland's corporate practice of medicine rule in a statute?

No single statute states it. The rule comes from the Board's position, the professional corporation laws and Attorney General opinions, and a 2000 Attorney General opinion noted that Maryland's highest court has never explicitly adopted the doctrine.

Can an MSO charge a percentage of revenue in Maryland?

Possibly, but carefully. A 1998 Attorney General opinion said a percentage fee must reasonably reflect the value of the services actually provided. A flat or cost-based fee is the more conservative design, and Maryland counsel should review it.

Can a nurse practitioner practice independently in Maryland?

Yes. Maryland NPs have full practice authority. A newly certified NP must name an advisory mentor, either an experienced NP or a physician, for the first 18 months.

Can out-of-state clinicians treat Maryland patients by telehealth?

Only with a Maryland license. Maryland has no out-of-state telehealth registration, so plan on full Maryland licensure for each physician, NP and PA.

Sources

For every other state, start with our corporate practice of medicine 50-state guide.

Launch in Maryland on a structure that is already built

MyOrbitHealth can form a PC-MSO structure for your brand, supply a physician PC owner or collaborating physician, or let you launch on its existing MSO / friendly-PC structure with 2,400+ licensed providers making every clinical decision. Explore PC-MSO formation and physician PC owner services, or book a call.