For months, we’ve been advising New York medical spa owners that enforcement risk is no longer theoretical.
Now, it’s official.
In December 2025, the New York City Council released a comprehensive Office of Inspector General (OIG) report on medical spas, outlining systemic concerns, regulatory gaps, and—most importantly—a clear roadmap for increased enforcement and interagency coordination. The report describes the findings from 15 medical spa inspections, giving concrete examples of non-compliance. The report also describes the post-inspection disciplinary proceedings against all 15 locations. Of the four locations whose matters have already been adjudicated, all have resulted in license revocation. Taken together, the report makes clear that regulators are prepared to act decisively. For medical spas that fail to meet compliance standards, their licenses are at stake.
Notably, the report also addresses the blurred line between medical spas and esthetician businesses. Businesses that only offer esthetician or cosmetology services are bound to separate licensure requirements than medical practices. Businesses offering both medical and spa services face conflicting information on licensure and regulatory requirements, leaving them vulnerable to enforcement risk.
This report matters not just because it exists, but because of what it signals:
New York is done with the “gray area” approach to medical spa regulation.
Why This Report Is a Big Deal
Unlike informal guidance or isolated enforcement actions, this report reflects a coordinated government posture. It pulls together concerns from multiple agencies and explicitly calls for tighter oversight of medical spas operating in New York City.
Historically, many med spa owners relied on:
- Limited enforcement bandwidth
- Fragmented oversight
- Inconsistent interpretations of scope and supervision
This report makes clear that those conditions are changing.
The Core Issues Identified in the Report
While the report is lengthy, its concerns fall into several key buckets that every NY med spa owner should understand.
1. Medical Oversight & Supervision Gaps
The report raises red flags around:
- Inadequate physician or qualified provider oversight
- Medical directors who are nominal, remote, or improperly structured
- Delegation of medical procedures without clear supervision protocols
In plain terms: paper medical directors and loose supervision models are now squarely on the radar.
2. Scope of Practice Violations
A major focus is whether individuals performing treatments are:
- Properly licensed
- Operating within their legal scope
- Adequately supervised under New York law
This includes scrutiny of:
- RN and NP delegation
- Use of unlicensed personnel
- Esthetic services crossing into medical procedures
Of the inspected businesses in the OIG report, 100% were found to be offering medical services without the required licensure and oversight. This indicates a widespread misunderstanding in provider scope and delegation requirements. “Everyone does it” is no longer a safe assumption.
3. Corporate Practice of Medicine (CPOM) & Ownership Structures
The report highlights concerns around:
- Non-physician ownership and control
- Improper MSO/PC or PLLC arrangements
- Financial structures that may improperly influence clinical decision-making
This is especially relevant for practices that scaled quickly or copied structures from other states without adapting them to New York’s stricter CPOM framework.
4. Advertising, Representations & Consumer Protection
The report flags misleading or confusing marketing, including:
- Overstating or misrepresenting medical credentials
- Misrepresenting services as “medical” or “doctor-led”
- Claims related to safety, outcomes, or approvals
Expect increased attention to websites, social media, and patient-facing materials—not just what happens inside the treatment room.
5. Patient Safety & Complaint-Driven Enforcement
The report emphasizes patient safety as the primary justification for increased oversight, noting that:
- Complaints are a key trigger
- Enforcement may be reactive to a singular violation at first—but broad once initiated
- Documentation, protocols, and training will matter significantly
Once an investigation starts, regulators tend to look at everything. What starts as a minor violation can put your license and practice at risk.
What This Means for New York Medical Spa Owners
This report does not mean that every med spa is about to be shut down.
But it does mean:
- Enforcement will be more coordinated
- Investigations will be more informed
- Excuses that once bought time will no longer work
Technology in the medical aesthetics industry evolves daily, often leaving the regulatory landscape trailing behind.The practices most at risk are not necessarily bad actors—they’re often well-intentioned businesses that grew faster than their compliance infrastructure.
Anticipate New Legislation:
The report gives a strong recommendation for state lawmakers to pass legislation requiring all esthetician and cosmetology businesses with Appearance Enhancement Business licenses to post clear notices affirming they are not licensed to perform medical procedures. This recommendation signals a growing interest in consumer protection in the medical spa industry, and suggests that other legislation focused on mandatory disclosures may follow. Providers should pay close attention to proposed legislation and prepare for these changes.
What We’re Advising Clients to Do Now
At Lengea Law, we’re not telling clients to panic. We’re telling them to prepare intelligently.
Key steps include:
- Reviewing medical director and supervision agreements
- Auditing delegation and scope-of-practice protocols
- Pressure-testing ownership and MSO structures
- Cleaning up advertising and website language
- Ensuring consents, policies, and documentation are current and defensible
The goal isn’t perfection—it’s alignment. Auditors tend to look favorably on practices taking corrective measures and investing in compliance. This means that identifying gaps, documenting remediation efforts, and demonstrating a good-faith commitment to meeting regulatory requirements can significantly mitigate enforcement risk.
The Bigger Picture: Enforcement as a Market Filter
Historically, regulatory shifts like this tend to do one thing well:
They separate practices that can scale responsibly from those built on shortcuts.
Operators who invest in compliance now are often the same ones who:
- Attract better providers
- Command higher valuations
- Sleep better at night
Final Takeaway
This report is New York putting the industry on notice. And it is doing so directly, formally, and publicly.
If you operate a medical spa in New York and haven’t revisited your legal and compliance framework recently, this is the moment to do so on your terms, not in response to a regulator’s letter.
We urge you to take this report seriously and work with a legal team on your med spa business.
This article is for educational purposes only and does not constitute legal advice.