Offshore Telemedicine: What Brazilian Law Requires in 2026

Opening a company abroad does not set aside Brazilian telemedicine rules. CFM Resolution 2,314/2022 requires the provider company to have its head office in Brazil, a CRM registration and a physician as technical lead. The LGPD also applies when the company is outside the country. An offshore structure serves, at most, for parts that are not the medical act.

Can I see Brazilian patients by telemedicine from an offshore company?

Not under the rule of the Federal Council of Medicine (CFM). Art. 2 of CFM Resolution No. 2,314/2022 (Resolução CFM 2.314/2022) allows telemedicine "within the national territory." Art. 17 goes further: legal entities that provide telemedicine services, communication platforms and data storage "must have a head office established in Brazilian territory" and be registered with the Regional Council of Medicine (CRM) of the state where they are based, with technical responsibility held by a physician registered with the same Council.

Law 14,510/2022 reinforces this design. Art. 3 makes it mandatory for companies that intermediate medical services, that is, legal entities that hire physicians, directly or indirectly, for telemedicine, to register with the CRM of the state where they are based. It also requires the registration of a medical technical director. Anyone who fails to comply is subject to item II of art. 10 of Law 6,437/1977.

In practical terms, a U.S. LLC or a company in another jurisdiction does not replace the Brazilian company registered with the CRM when the patient is in Brazil. What the text does not resolve are specific cases, such as seeing patients who are in another country. In those cases, that country's rules also apply, and it is worth confirming with the CRM and with a local lawyer. Always check whether there is a CFM rule issued after the cited resolution, on the CFM portal.

What does the telehealth law require of remote care?

Law 14,510/2022 authorizes and regulates telehealth throughout the national territory. Art. 26-A, added to Law 8,080/1990, lists the principles: professional autonomy, the patient's free and informed consent, data confidentiality and the right to refuse remote care, with a guarantee of in-person care whenever requested.

Acts performed through telehealth are valid throughout the national territory (art. 26-B, sole paragraph). The ethics of the service are regulated by the federal councils of each profession, with the standards of in-person care (art. 26-D). And the practice must comply with the Internet Civil Framework (Marco Civil da Internet), the Medical Act Law, the LGPD, the Consumer Protection Code and, where applicable, the Electronic Medical Record Law (art. 26-G, II).

Art. 26-H waives the secondary or complementary registration of a professional who practices the profession in another jurisdiction exclusively through telehealth. The text does not say this applies to companies based abroad, and CFM Resolution 2,314/2022 continues to require a Brazilian head office for the legal entity.

Does the LGPD apply if the company and the servers are abroad?

Yes, when the processing involves people in Brazil. Art. 3 of the LGPD (Brazil's General Data Protection Law) applies regardless of the country of the company's head office or the country where the data is located, as long as the operation takes place in the national territory or aims to offer services to individuals located in Brazil, or to process their data.

Health data is sensitive personal data (art. 5, II), and can be processed only in the cases of art. 11. If the servers are outside the country, international transfer is allowed only in the cases listed in art. 33, such as countries with an adequate level of protection or safeguards offered by the controller, for example specific contractual clauses or standard clauses. Hosting the medical record abroad, therefore, requires a legal basis and an appropriate contract. For the view of a company operating in several countries, see the guide on GDPR and LGPD for offshore companies.

CFM Resolution 2,314/2022 also requires that the patient's data and images in the medical record be preserved in accordance with the legal rules and those of the CFM on custody, integrity, confidentiality and professional secrecy (art. 3).

What is an offshore structure for in a digital health business?

For the part of the business that is not the medical act, and only after validating each use. Examples of legitimate questions: where the ownership of the brand and the software sits, who contracts international suppliers and how the business receives payments from clients outside Brazil. Each answer has to go through the rules of the CFM, the LGPD and the law of the country where the entity operates.

What does not work is treating the structure as a shortcut around the CRM or Brazilian tax. If the physician or the partner lives in Brazil, the taxation of the foreign entity comes into the conversation, as explained below. For the profile of the physician thinking about a structure abroad, see offshore for physicians: protection and tax savings and the Brazilian physician case study.

How does Law 14,754 tax the foreign company of a partner resident in Brazil?

Law No. 14,754/2023 (Lei 14.754/2023) requires the resident to report, on the Annual Adjustment Return, income from financial investments and profits and dividends of controlled foreign entities (art. 2). The rate on the annual portion of the income is 15% (art. 2, § 1).

The profits of a controlled entity are taxed on December 31 of each year in the cases of art. 5. Two conditions define the regime:

The law defines own active income as revenue from the entity's own economic activity, excluding revenue arising exclusively from royalties, interest, dividends, equity interests, rent, capital gains (with exceptions), financial investments and financial intermediation (§ 6). An entity that only receives royalties for the use of software, for example, has no own active income under this concept. Since each case depends on the facts and the country, ask for a tax analysis before engaging.

See also Offshore Proz's tax planning page.

What questions should I ask before setting up the business?

Answer these questions with documents, not assumptions:

1. •Where will the patients be? If they are in Brazil, the CFM and LGPD rules apply.
2. •Where will the head office of the legal entity providing the service be? CFM Resolution 2,314/2022 requires a head office in Brazil.
3. •Who will be the medical technical director and with which CRM are they registered?
4. •Where are the medical records kept and what is the legal basis for international transfer, if any?
5. •Who controls the foreign entity and how will it be taxed under Law 14,754/2023?
6. •Is there a CFM or CRM rule in your state newer than the sources cited here?