Even before the COVID-19 crisis, health care providers were drawn to “offshoring” certain health care and administrative services. This presentation will examine the regulatory environment for such offshored services, especially with respect to the provision of telemedicine. In addition, the presentation will examine the risks and regulatory requirements of outsourced, offshore administrative functions such as billing and management services. The presentation will examine the federal regulatory issues (including HIPAA and Medicare), as well as state-level laws and regulations which can affect whether such services are permissible, what requirements apply, and what potential pitfalls await physician practices and other health care providers that decide to avail themselves of offshore services. Finally, the presentation will look at how the COVID pandemic has affected the application of the rules.