NEWS

Locums, Moonlighting, Telehealth Side Gigs: Are You Actually Covered?

October 27, 2025

A lot of groups still talk about their clinicians like this: “She works for us full-time, so we’re covered under our policy.” That’s not how most clinicians are working anymore. It’s now completely normal for one physician (or NP, PA, CRNA) to have three different income streams at the same time:

Full-time or part-time clinical work for your group
Telehealth shifts for a virtual clinic that may be based in another state
Weekend or short-term locums / urgent care coverage as a 1099

Everyone involved thinks “someone else is covering that risk.” Then a claim hits, and suddenly the employer’s name is on the lawsuit for something that didn’t even happen in their building. Let’s talk about why this happens — and what to do about it.

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Why this is accelerating

Burnout, staffing shortages, and pay pressure all push clinicians to pick up extra work. Telehealth made it easy to “see patients anywhere,” and locums agencies normalize short-term placements across state lines. A lot of leadership teams don’t actually know where (and under which policy) their providers are practicing.

From a liability standpoint, that matters. Because when a patient attorney files, they don’t just name the clinician. They name anyone who even looks like they might be responsible.

If that clinician’s bio, LinkedIn, or introduction to the patient implied affiliation with your group, you can get named — even if the clinical encounter was somewhere else.

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Blind spot #1: “Their side work isn’t our problem”

The classic assumption is: “If Dr. Patel is moonlighting in Urgent Care X, that’s covered by Urgent Care X. If they get sued, it’s on Urgent Care X.” In practice, plaintiffs often argue “apparent agency.” Translation: the patient thought Dr. Patel was acting as part of your organization — or that your organization should have known how Dr. Patel practices in general. Your entity can get pulled in just because you’re seen as the deepest pocket in the room. So even if you had nothing to do with that shift, you can still spend money defending it.

Takeaway: you can be named in a case you didn’t bill, staff, supervise, or even know about.

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Blind spot #2: State lines and licensure

Telehealth and traveling locums make geography messy.

Example: Your group is based in New York. One of your clinicians is doing telehealth consults for patients physically located in Pennsylvania. There’s a bad outcome. A complaint is filed in Pennsylvania.

Question: is your policy written to respond to an incident in Pennsylvania, for a patient you’ve never seen, under a telehealth contract you didn’t negotiate?

Also: if there’s a licensing/board issue in that other state, it can follow that clinician back into your practice’s credentialing. That becomes your problem even if the patient never touched your facility.

Takeaway: “We don’t operate there” is not a shield if your clinician does.

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Blind spot #3: Scope drift

When clinicians moonlight, they sometimes work slightly “bigger” than they do for you. Maybe they prescribe independently at an urgent care when at your facility they write under tighter protocols. Maybe they do procedures off-hours they’re not privileged to do in your OR. If that goes badly somewhere else, plaintiff counsel will absolutely try to connect it back to you: “This clinician practices beyond safe scope, and the employer either knew or should have known.” That’s ugly to defend if you don’t even track what off-hours work looks like.

Takeaway: any recurring pattern in how that clinician practices off-site can come back into your world as a reputation / supervision argument.

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Blind spot #4: Tail coverage (claims-made timing)

Most medical professional liability (MPL) coverage is claims-made. That means it’s not about when the care happened — it’s about when the claim is filed.

Here’s the trap:

Clinician does a short locums contract.
Clinician leaves.
Locums site’s policy ends.
Eighteen months later, a claim surfaces.

Who’s holding the tail? The locums site may say “not us, they’re gone.” Plaintiff includes your group in the filing because you’re still alive and insured. Now you’re in the claim story for an encounter you didn’t schedule, staff, or bill. If you don’t know who’s responsible for tail coverage on those side gigs, you’re potentially volunteering as the adult in the room by default.

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So what should a practice actually be doing?

Here’s the part that matters during renewal.

1. Ask every provider, in writing, on a repeating schedule (quarterly or at renewal):

Are you doing any clinical work outside this organization?
Where? (List facilities, states, telehealth platforms.)
W2 or 1099?
Do you have a policy for that work? Claims-made or occurrence?
Who’s responsible for tail if/when you stop doing that work?

If that sounds intrusive, think about the alternative: “Find this out for the first time in a deposition.”

2. Track state exposure.
For each outside site or telehealth arrangement:

Is the clinician licensed in that state?
Are you prepared to answer “yes, we knew and it’s documented,” if asked by a carrier or a plaintiff?

3. Track scope.
Ask: Are you doing anything in those settings you are not credentialed/privileged to do here?
That’s not about shutting it down. It’s about not being surprised later if opposing counsel frames it as a pattern.

4. Get proof, not just assurances.
Ask for the dec page / certificate of insurance from each outside gig. Save them.
Verbal “Yeah I’m covered” is not enough when your entity gets named.

5. Put expectations in your handbook.
Have a simple policy that says:

If you do outside clinical work, you must disclose it.
You must carry appropriate coverage for it.
You must update us if that changes (especially if you leave that side gig).

This isn’t “you can’t moonlight.” This is “if we’re going to be dragged into it, we need a defense story.”

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How this plays with underwriters

Here’s the good news: underwriters already assume side gigs are happening. Hiding it doesn’t make you look clean — it makes you look unaware.

What lands better:
“We require all providers to disclose any telehealth, locums, or PRN work. We keep copies of their outside coverage. We document which states they touch and how tail is handled.”

That reads like: we manage and surface risk instead of pretending it doesn’t exist. That positioning tends to help with terms in a tough MPL market.

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Bottom line

Clinicians stacking jobs is the new normal. The liability model has not caught up. If you’re still relying on “We’ve never had a claim” as your comfort blanket, you’re exposed. You can get named in a lawsuit for work you didn’t authorize, in a state you don’t operate in, under a scope you didn’t credential, 18 months after the fact.

This is now a basic part of renewal prep:

Know where your clinicians are practicing.
Know who insures that work.
Know who owns the tail.

Western Summit can help you build that picture before you’re in front of an underwriter — and before you’re answering those questions under oath.