> ## Documentation Index
> Fetch the complete documentation index at: https://www.practiceownersguide.com/llms.txt
> Use this file to discover all available pages before exploring further.

# CPOM by state

> Which states restrict non-physician ownership of medical practices, grouped by enforcement intensity, with sources.

<Warning>
  Not legal advice, and CPOM is enforced through a patchwork of statutes, board
  opinions, and case law that changes. Use this table to calibrate, then verify
  your state with a healthcare attorney before structuring anything.
</Warning>

More than 30 states restrict non-physician ownership of medical entities
(source: [BMD](https://www.bmdllc.com/resources/blog/friendly-physician-models-the-basics-through-5-frequently-asked-questions/)).
Enforcement intensity is what actually varies. A practical grouping,
following healthcare counsel surveys
([GuardianMD](https://guardianmedicaldirection.com/news/overview-and-guide-for-corporate-practice-of-medicine-cpom-laws-pc-mso-models-and-state-rules/),
[ByrdAdatto](https://byrdadatto.com/banter/mso-to-navigate-cpom/)):

| Tier       | What it means                                                                                                                 | Representative states                                                                                     |
| ---------- | ----------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------- |
| Strict     | Active enforcement; PC ownership by licensed physicians required; MSO arrangements scrutinized (fee structure, control terms) | California, New York, Texas, New Jersey, Colorado, North Carolina                                         |
| Moderate   | Doctrine exists with carve-outs or lighter enforcement; structures work with standard guardrails                              | Much of the middle of the country; some allow co-ownership by other licensed professionals (e.g. Arizona) |
| Permissive | No formal CPOM doctrine; non-physicians may own practices through ordinary entities                                           | Florida, Illinois, and a minority of others                                                               |

Three cautions when using the tiers. Permissive does not mean unregulated:
fee-splitting and kickback statutes still apply everywhere (Florida is the
canonical example). The doctrine is specialty-specific: dental has its own
ownership statutes in most states, and they're often stricter than medical.
And tier boundaries move: several states have proposed tightening MSO
oversight in recent legislative sessions, so re-verify before each new state.

## How to use this

Starting a practice as a clinician: your state's tier mostly affects which
[entity](/guides/choose-your-entity) you form. Building as a non-physician or
expanding multi-state: the tier determines how much structure you need,
[the MSO/PC playbook](/guides/own-a-practice-without-a-license), and the
strictest state in your footprint sets your compliance bar
([expansion](/guides/expand-out-of-state)).

State-by-state statute detail lives at the companion
[MSO-PC Wiki](https://mso.getlemma.com).

## Related

* [The PC and corporate practice of medicine](/concepts/cpom-and-the-pc)
* [Choose your legal entity](/guides/choose-your-entity)
* [Owning a practice when you're not a physician](/guides/own-a-practice-without-a-license)
* [Entity types by state](/reference/entity-types-by-state)
* [Expand out of state](/guides/expand-out-of-state)