4 Tips and Tricks in Avoiding The Most Common Telemedicine Malpractice (With Examples)

Today's healthcare professionals want to do right by their patients. Sometimes that means thinking about how we improve business processes and using the best tools for the job.

Telemedicine is no longer an emerging practice or a novelty in healthcare. The rapid shift to virtual care during the COVID-19 pandemic fundamentally changed the landscape. Between 2019 and 2020, telehealth utilization skyrocketed by over 7,000%. Now, in the post-pandemic landscape of 2026, providing healthcare remotely via phone, text message, or video conferencing is a standard, everyday practice. It remains especially vital for patients with limited mobility or those living in remote parts of the country.

However, like all technologies, there are easy ways to misuse it. In the world of healthcare, that can have serious consequences. Medical malpractice occurs when a healthcare professional neglects to provide appropriate treatment, takes inappropriate action, or gives substandard treatment that causes harm, injury, or death to a person. Historically, there has been an average of around 47,000 medical malpractice suits every year.

Just as with standard healthcare, there are circumstances where telemedicine malpractice can occur. The most common malpractice errors in telehealth include misdiagnosis, failure to treat, and prescribing errors (such as prescribing the wrong medication, the wrong dosage, or a drug the patient is allergic to). It is vital for any professional involved in telemedicine to be aware of what issues they may face and to ensure that they provide a reasonable standard of care.

Addressing the Risks of Telemedicine

Keeping patients at a distance from their healthcare providers inspires some concerns. Some relate to whether people can access telemedicine in the first place, but many more are around the standard of care provided during contact. As such, healthcare providers risk opening themselves up to accusations of malpractice. To avoid such a scenario, here are some key concerns to think about when you're communicating with patients.

#1. Technical challenges

This is one of the most obvious concerns and one of the easier ones to address. While app testing lets us spot problems before a product releases, it's not always plain sailing. It's likely that even with a good internet connection, you'll sometimes have to contend with glitches, dropped video or audio, or even a struggle to connect in the first place.

Healthcare professionals can also encounter issues with other tasks, such as transferring files digitally from one place to another. The files themselves can become corrupted, or the wrong files can be transferred.

More serious issues arise when we have to transcribe medical records. A misinterpreted note can, naturally, have serious medical consequences for a patient. This problem becomes more likely if we outsource the transcription of written messages to people without medical experience. All of these make it more likely a poor level of healthcare is provided, with an increased risk of legal action from your patients.

Another solid strategy here is to, as much as possible, have another professional with you during conversations. The specific person doesn't matter much, provided they have a baseline of medical expertise (like a nurse or physician assistant). Virtual team communication tools can help you set this up. One thing that may help in this area is AI audio transcription, which may prove to reduce the occurrence of human error.

#2. Diagnosis hurdles

While telemedicine can bridge gaps between doctors and patients, some situations demand in-person contact. Focusing too much on using telemedicine because it's convenient can mean you miss some signs of illness, something that may leave you open to a charge of malpractice. In fact, misdiagnosis is the number one telehealth malpractice risk. A recent study showed that over 70% of telehealth malpractice claims are related to misdiagnosis.

A fundamental legal principle governs this area: the telehealth standard of care is legally equivalent to in-person care. Doctors cannot use the limitations of technology as an excuse for providing substandard care that leads to patient harm. If a virtual visit cannot provide the diagnostic accuracy that an in-person visit would, the provider is obligated to recommend an in-person assessment.

For example, doctors may sometimes need to palpate an area of a patient's body to identify the issue accurately. Lacking these options could compromise a doctor's ability to diagnose a problem, and virtual meeting best practices (while important) can't alleviate these issues.

Telemedicine can also present diagnosis problems in branches of medicine where you wouldn't expect to find them. On the surface, radiology seems like a practice that benefits from telemedicine. This is because much of it revolves around looking at various texts and images, such as X-rays, MRI scans, ultrasounds, etc.

While today's technology makes accessing these images simple, its ease of use may unwittingly increase the professional's workload. This may mean they fail to spot crucial signs of illness.

To alleviate this problem, it's vital to consider if telemedicine is an appropriate choice for each specific situation, especially if a hands-on approach is necessary. When you need to participate in a telemedicine appointment, ensure you keep highly accurate and comprehensive records of what transpired. A voice transcription tool can assist in this kind of task.

EHR-Related Malpractice Risks

Electronic Health Records (EHRs) are essential to telehealth, but they introduce their own malpractice risks. When telemedicine platforms are not properly integrated with a clinic's main EHR system, patient records become dangerously fragmented. A doctor making a clinical decision via video may only see part of the patient's medical history, increasing the risk of misdiagnosis and subsequent telemedicine malpractice claims.

Beyond fragmentation, EHR workflows introduce several additional liability vectors worth understanding:

Copy-paste errors and note bloat. Copying forward prior visit notes without reviewing them is one of the most common EHR-related sources of clinical error. In a telehealth context, where the provider has less physical examination data to anchor a note, copy-forwarded content can propagate inaccuracies across multiple encounters. Courts have treated copy-paste errors as evidence of inattentive documentation, which strengthens a plaintiff's negligence argument.

Alert fatigue. Modern EHRs generate a high volume of safety alerts: drug interaction warnings, allergy flags, and overdue preventive care reminders. Providers who click through alerts rapidly during a busy telehealth session risk missing a critical warning that an in-person encounter might have prompted them to pause on. A missed critical drug interaction flagged but overridden in the EHR is a documented liability event.

Integrated telehealth-EHR workflows reduce risk. When the telehealth platform and the EHR are tightly integrated, the provider has access to the patient's full medication list, prior diagnoses, and recent lab values during the virtual visit. That complete picture is exactly what closes the diagnostic gap that drives misdiagnosis claims. Choosing a practice management system that connects telehealth encounters directly to the clinical record is one of the most practical steps a provider can take to reduce EHR-related malpractice exposure.

#3. Regulations

Even if you can resolve some of the issues with the distance that telemedicine presents, you should check if there are roadblocks around actually prescribing a treatment. For example, the US state of Arizona doesn't allow pharmacies to distribute drugs using prescriptions given via telemedicine. In-person checkups are also required in this scenario to avoid legal consequences.

It's also important that you're licensed to practice medicine in the right areas. US law typically states that clinicians must be licensed in the state where their patient resides rather than where the clinician practices. While this isn't often an issue with in-person appointments, the rise of telemedicine presents new issues. This is particularly challenging when patients travel or live across state borders. Geolocation tools can help verify a patient's location at the time of a virtual visit, but providers must remain vigilant about this requirement.

The regulatory landscape shifted dramatically during the COVID-19 public health emergency. Emergency waivers temporarily eased multi-state licensing restrictions and allowed broader prescribing via telehealth. Since the formal end of the federal public health emergency in May 2023, Congress has repeatedly extended specific telehealth flexibilities through short-term legislative measures rather than allowing them to expire outright. As of 2026, several of these extensions remain in place, but they have been renewed in relatively brief increments, meaning the rules can change on short notice. Multi-state prescribers should not assume current flexibilities are permanent. Providers must monitor legislative developments closely and re-verify that their cross-state practices remain fully compliant each time an extension period approaches its deadline.

Controlled-substance prescribing and the Ryan Haight Act. For providers prescribing controlled substances via telehealth, an additional layer of federal regulation applies. The Ryan Haight Online Pharmacy Consumer Protection Act generally requires at least one in-person medical evaluation before a practitioner may prescribe a controlled substance via the internet. During the COVID-19 public health emergency, the DEA issued waivers that allowed controlled-substance prescribing via telemedicine without that prior in-person visit. The DEA has subsequently proposed and extended telemedicine prescribing rules to preserve some of those flexibilities in a structured form, but the final regulatory framework has been subject to repeated delays and short-term extensions. Providers prescribing Schedule II through V substances to telehealth patients must confirm current DEA rule status before each prescribing period, as this is among the highest-liability areas in US telehealth practice.

Consider other relevant legislation, like the Health Insurance Portability and Accountability Act. HIPAA demands that healthcare providers safeguard protected health information (which varying types of data ingestion can help with) that could influence things like your choice of technology.

Healthcare providers must also prioritize cybersecurity in telehealth to prevent devastating data breaches. Telehealth platforms are frequent targets for cyberattacks, and hidden data trackers on these portals can inadvertently leak sensitive patient information to third-party advertisers. If a provider's virtual care platform is compromised, they may face severe malpractice claims and regulatory fines. Implementing end-to-end encryption and using only secure, HIPAA-compliant software is essential to shield patient data from these escalating digital threats.

While we've already touched upon call quality from a technical perspective, it's also crucial to consider platform security from a regulatory one. It's unlikely that you would use them, but it's best to avoid the likes of Facebook Live and Twitch in this context.

Ensure that the platform you choose cannot be hacked (or eavesdropped on) to remain in compliance with HIPAA. Register your domain names in the territory in which you operate — purchase domain name Canada, for example, if that's where your practice is based.

Informed consent in telehealth deserves more than a passing mention. It's easy to treat consent as a formality in a virtual setting, given the more informal nature of a video call, but cutting corners here is a genuine liability risk. Proper telehealth informed consent should cover: the specific limitations of virtual care compared to an in-person visit (such as the inability to perform a physical exam); the patient's right to choose an in-person visit instead; what will happen in an emergency during or after the virtual encounter and how the patient should seek help; and the privacy and security risks inherent in transmitting health information over the internet. Some US states require written consent for telehealth, while others accept verbal consent documented in the record. Providers should check the requirement for each state where their patients reside and document the consent discussion in the visit note, including the format used and the patient's acknowledgment.

Address this problem by thoroughly understanding the legalities of practicing and prescribing medicine in your area. There may be lessons you can learn from other industries in how to manage collection of medicines. You may also benefit from brushing up on the concept of informed consent and how to properly apply it in a telemedicine environment. Be aware that the law in this area of medicine may shift rapidly over a short period.

Physician Burnout and Virtual Care

The rapid shift to virtual care and increased EHR administrative tasks have worsened physician burnout, directly catalyzing telemedicine malpractice risk. Exhausted providers are more likely to take documentation shortcuts, such as truncating visit notes or copying forward prior entries without review, and diagnostic shortcuts, such as anchoring on an initial impression without fully considering alternatives. Both patterns increase liability exposure meaningfully. Reduced attention during virtual visits is also a concrete concern: a provider managing screen fatigue across back-to-back video appointments is more likely to miss a subtle symptom or overlook a critical alert. Managing screen fatigue, building sustainable scheduling practices, and streamlining digital documentation are therefore not just wellbeing strategies. They are direct risk-reduction measures that protect both patients and providers.

When Does the Physician-Patient Relationship Begin in Telemedicine?

Understanding when the physician-patient relationship is established is foundational to any telemedicine malpractice analysis. Before a malpractice claim can even be brought, a plaintiff must demonstrate that a duty of care existed. In traditional medicine, that duty is straightforward to establish: the patient books an appointment, attends the clinic, and the clinician begins an evaluation. In telemedicine, the starting point is far less obvious.

Consider some common scenarios. A patient submits an intake questionnaire through a direct-to-consumer telehealth platform; a physician reviews it asynchronously hours later and sends a response. Does a physician-patient relationship exist from the moment the questionnaire is submitted, or only when the physician replies? What about a provider who answers a general health question sent through a patient portal? Courts have treated informal digital interactions as sufficient to establish a duty of care in some cases, particularly where the provider's response is individualized and the patient could reasonably have relied on it for clinical guidance.

The practical implication is significant. Providers must ensure that the beginning and end of every virtual consultation are clearly documented. Onboarding language for patient portals and direct-to-consumer platforms should specify when a clinical relationship begins and when it does not. Explicit, documented informed consent obtained before the encounter starts is one of the most effective tools for establishing a clear framework and limiting ambiguity around when the duty of care attaches.

Telemedicine Malpractice Insurance

As the use of telehealth grows, so does the need for specialized risk management. Telemedicine malpractice insurance is the professional liability coverage designed specifically for the unique risks of virtual care, and every provider offering telehealth services should verify that their policy explicitly covers it. A standard malpractice policy may not automatically cover telemedicine services, especially when provided across state lines. If a policy only covers in-person visits, a malpractice claim stemming from a video consultation could be denied entirely.

Does Malpractice Insurance Cover Telemedicine?

Not automatically. Whether a standard professional liability policy covers telehealth depends on the carrier and the specific policy language. Many insurers attach scope-of-practice conditions, meaning coverage applies only to services within the provider's licensed specialty and only in states where the provider holds an active license. Some carriers require providers to notify them before adding telehealth services; others include telehealth as a standard feature of a policy but exclude cross-state encounters unless a multi-state endorsement is added. The safest course of action is to contact your carrier directly and ask for written confirmation that your current policy covers telemedicine, including the states where your patients reside. Do not assume that a general professional liability policy is sufficient without that confirmation.

Providers practicing virtual medicine may need dedicated telemedicine malpractice insurance. This specific professional liability coverage for telehealth addresses risks such as misdiagnosis due to physical exam limitations, multi-state jurisdictional issues, and patient abandonment following a dropped connection or missed follow-up. Because of the relative novelty and evolving risk profile of virtual care, providers should compare policy options carefully.

Crucially, telemedicine-specific coverage addresses the risk of patient abandonment. In virtual care, it is much easier to lose touch with a patient who misses a follow-up or experiences technical issues. If a provider fails to safely transfer care or follow up after a dropped connection, they could be held liable for abandonment. When securing a policy, clinicians should ensure it covers all the states where their patients reside and that it meets the specific policy limits required by each state's telehealth regulations.

#4. The personal touch

While it's harder to quantify, it's important to consider what kind of relationship you're building with your patients. This is because the better your relationship with them, the lower the chance they will sue you for something you've done (or failed to do).

While this might be because you're offering a better standard of healthcare (and things like online booking) it's often because things like empathy and compassion are best conveyed when we're in a face-to-face meeting, and it's harder to sue someone you care about. This contact allows medical professionals to build a rapport with patients, better understand their problems, and help patients feel that somebody cares about them.

It is possible to have this kind of personal touch during a telemedicine conversation, but it requires a conscious effort and training to carry off properly. As such, this is another reminder that telemedicine is best used as a supplement to conventional patient appointments rather than a replacement for them.

Don't forget to take care of yourself, either. You need to know how to deal with professional burnout to ensure you provide quality healthcare.

The Takeaway

There is little doubt that telehealth offers many benefits, both to patients and to healthcare professionals. However, it is important to note its limitations and the potential for errors to be made. Some things that may be used to give an accurate diagnosis, such as an MRI scan, are impossible to carry out by phone. But when used properly, telemedicine can help overworked professionals and can also benefit patients living in remote or rural areas.

As some of the potential errors that can lead to malpractice are the same in both standard healthcare and telemedicine, it's essential that professionals try to maintain the same standard of care in both areas. If there is doubt, then a professional healthcare provider should consult with a colleague or a more senior practitioner. There is nothing wrong in admitting you are unsure about something. In fact, it's quite the opposite and can reflect positively on your professionalism.

One thing you need to consider strongly if you're practicing telehealth is confidentiality. You need to ensure that you are complying fully with HIPAA regulations and that any communications equipment you use, and how you store patient data, will not allow accidental information leaks or be susceptible to cybercriminals' attacks.

Take Your Healthcare to the Next Level

Telemedicine is an invaluable tool for healthcare professionals nowadays, as we increasingly use technology to bridge long distances. It can be the perfect way of providing healthcare to people traditionally deprived of it. From that perspective, telemedicine shouldn't be overlooked by any healthcare provider.

At the same time, it's integral to recognize telemedicine's drawbacks, particularly around security and the overall standard of healthcare. It's essential to work consciously to alleviate these problems and recognize telemedicine isn't a silver bullet.

Frequently Asked Questions

1. Can a doctor physically examine me during a telehealth visit?

A doctor cannot perform a traditional hands-on physical exam through a screen. They rely on visual assessments, patient-reported symptoms, and reviewing vital signs from remote monitoring devices. If a physical exam is strictly necessary to make an accurate diagnosis, the provider should instruct the patient to seek immediate in-person care.

2. Does signing a telehealth user agreement waive my right to sue?

Signing a user agreement or an informed consent form for a telehealth platform does not waive your right to sue for medical negligence. These documents acknowledge that you understand the inherent limitations of virtual care, such as technology failures. However, they do not protect a doctor from legal liability if they provide substandard care that causes you harm.

3. Does malpractice insurance cover telemedicine?

Not automatically. Whether a standard professional liability policy covers telemedicine depends on the carrier and specific policy language. Many insurers attach conditions tied to licensed specialty and state of practice, and some exclude cross-state telehealth encounters unless a specific endorsement is added. Providers should contact their carrier directly and request written confirmation that their policy covers telehealth before offering virtual care services.

4. Did Congress extend telehealth in 2026?

Congress has repeatedly extended federal telehealth flexibilities in short-term increments since the formal end of the COVID-19 public health emergency in May 2023. As of 2026, several extensions remain in place, but they have not been made permanent. Providers should monitor legislative developments closely, as the rules can change on short notice when an extension deadline approaches.

5. What are the 7 C's of malpractice?

The 7 C's of malpractice are a clinical risk management framework: Competence, Communication, Consent, Confidentiality, Charting, Continuing education, and Credentials. In a telemedicine context, each one maps to a concrete practice: verifying licensure in the patient's state (Credentials), documenting telehealth encounters thoroughly (Charting), obtaining and recording informed consent before the virtual visit begins (Consent), using only HIPAA-compliant platforms (Confidentiality), and staying current on evolving telehealth regulations (Continuing education).

6. What is the 7-day rule for telehealth?

The 7-day rule is not a single uniform federal regulation. The term is used in different contexts: some state Medicaid programs and private payers have used a 7-day window as a follow-up requirement after certain telehealth encounters, and the DEA's proposed telemedicine prescribing framework has referenced time-limited prescribing windows for controlled substances. Because the rule's definition varies by payer and state, providers should confirm the specific requirement with their payer contracts and state telehealth regulations rather than relying on a single definition.