Telehealth is where a large share of PMHNP jobs are, and most telehealth employers run careful clinical operations. The difficulty is that a well-run company and a risky one can look identical in a job posting. The difference shows up in the answers to specific questions.
Vet a telehealth psychiatry employer on four things: who controls clinical decisions, how you are paid, how the company handles controlled substances, and what the contract makes you personally responsible for. The federal Done Global case is the reference point. Prosecutors described visit time caps, automated refills, and pay tied to prescription volume, and licensed prescribers were convicted along with executives. If an employer's model depends on any of those, walk away.
Why This Matters More Now
In November 2025, a federal jury convicted the founder and the clinical president of Done Global, a subscription telehealth company that treated ADHD, of conspiring to distribute controlled substances and to commit health care fraud. In July 2026 the founder was sentenced to 72 months in prison and the clinical president to 24 months, each with a $1 million fine.
The Justice Department's description of the company's practices is the useful part for anyone reading a job offer:
- An "auto-refill" feature that sent prescriptions after an initial diagnosis, to minimize follow-up appointments
- Pressure on clinicians to diagnose ADHD in initial visits "capped at half the length of a typical examination"
- Payments of "up to $60,000 per month to clinicians who signed Adderall prescriptions every 30 seconds"
- A refusal to pay for follow-up treatment
The accountability did not stop with executives. On October 2, 2026, the department announced the conviction of a physician who prescribed through the platform and said he was the eleventh defendant convicted, a group that includes six other licensed prescribers.
The lesson is direct. Your license and DEA registration are yours. A company policy is not a defense for a prescription you signed.
Red Flags That Match What Prosecutors Described
| What you see | Why it is a problem | What to ask |
|---|---|---|
| Fixed short intake visits | A psychiatric evaluation needs enough time to rule out other causes | Who sets visit length, and can I extend a visit when the case needs it? |
| Refills sent without clinician review | Every controlled prescription needs a clinical decision behind it | Walk me through what happens between a refill request and the prescription |
| Pay that rises with prescriptions written | It rewards prescribing over care | Does any part of my pay depend on whether I prescribe? |
| Follow-ups discouraged or unpaid | Monitoring is part of the standard of care | How often are follow-ups scheduled, and are they paid? |
| A diagnosis expected at the first visit | It removes clinical judgment | What happens when I do not think a patient meets criteria? |
A good employer answers these questions easily and usually has the policy in writing.
Questions About Clinical Control
- Who is the clinical leader, and are they a practicing psychiatric clinician?
- Can I decline to prescribe, taper a medication, or request an in-person evaluation without it counting against me?
- How is the prescription drug monitoring program checked, and is that time built into the visit?
- What is the expected panel size and daily visit count at full ramp?
- Who can I call during the day with a clinical question?
Questions About Pay
Per-visit and productivity models are common and not a problem by themselves. Ask what is and is not paid.
- Is documentation time, chart review, and prior authorization work paid?
- What happens to my pay when a patient does not show?
- Is there a guaranteed minimum during the ramp period?
- Am I a W-2 employee or a 1099 contractor, and who pays malpractice?
If the role is 1099, run the offer through our 1099 vs W-2 calculator before you compare it to a salaried one. An hourly contract rate has to cover self-employment tax and benefits you would otherwise receive. The offer analyzer shows where a salary lands against advertised pay in live postings.
Questions About the Federal Prescribing Deadline
The federal rule that allows controlled substances to be started by telehealth without an in-person visit runs through December 31, 2026. A permanent replacement is under government review and its contents are not public. Ask every telehealth employer:
- What is your plan for January 1, 2027 if no rule replaces the current one?
- Do you have a way to arrange in-person evaluations for patients on controlled medications?
- Which of my patients would be affected, and who is responsible for transitioning them?
An employer that has not thought about this is telling you something. Our DEA telehealth deadline guide explains the rule and the possible outcomes.
Questions About Licenses, Registrations, and Malpractice
- Which state licenses and DEA registrations do you want me to hold, and who pays for them and their renewals?
- If I leave, do I owe any of those costs back?
- Who is the collaborating or supervising physician in states that require one, and what happens if that physician leaves?
- Is malpractice coverage occurrence-based or claims-made? If it is claims-made, who pays for tail coverage?
- Does the contract ask me to indemnify the company?
Read the restrictive covenants as well. Several states now limit noncompete agreements for health care practitioners, and our noncompete guide covers what changed.
How to Check the Company Itself
- Search for enforcement and litigation. Look for the company name with terms such as settlement, indictment, and board action.
- Ask to speak with two current clinicians. A company confident in its model will arrange it.
- Read the clinical policies, not only the offer letter. Ask for the controlled substance policy and the escalation policy for patients in crisis.
- Check how patients are acquired. Advertising that promises a specific medication is a warning about the pressure you will face in visits.
- Notice how they handle your questions. Defensiveness about compliance is itself an answer.
What a Sound Employer Looks Like
- Visit lengths set by clinicians, with room to extend
- Written prescribing policies that leave the decision with the prescriber
- Pay that does not change based on whether a prescription is written
- Regular supervision or peer consultation, especially in the first year
- A clear answer on the December 31, 2026 prescribing deadline
- Licenses, registrations, and malpractice costs spelled out in the contract
Many employers meet that standard. You can browse current telehealth PMHNP jobs and remote PMHNP jobs, and our overview of telehealth companies hiring PMHNPs is a starting list to which you can apply the questions above.
Sources
- U.S. Department of Justice, Founder/CEO and Clinical President of Digital Health Company Convicted (November 19, 2025): https://www.justice.gov/opa/pr/founderceo-and-clinical-president-digital-health-company-convicted-100m-adderall
- U.S. Department of Justice, sentencing announcement (July 7, 2026): https://www.justice.gov/opa/pr/founderceo-and-clinical-president-digital-health-company-sentenced-8-years-90-million-scheme
- U.S. Department of Justice, Doctor Convicted of Conspiring to Distribute Over 2 Million Stimulant Pills (October 2, 2026): https://www.justice.gov/opa/pr/doctor-convicted-conspiring-distribute-over-2-million-stimulant-pills
- DEA and HHS, Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities, 90 FR 61301: https://www.govinfo.gov/content/pkg/FR-2025-12-31/html/2025-24123.htm