Could telehealth services make you eligible for Puerto Rico's 4% tax rate and 0% capital gains?

Dr. Chacon speaks with Víctor Delerme, CPA, founder of Delerme CPA with offices in San Juan, Miami, and Atlanta. With over 16 years of experience and licenses in both Puerto Rico and Georgia, Víctor specializes in helping high-income physicians, entrepreneurs, and investors dramatically reduce their tax burden through Puerto Rico's Act 60 incentives. What if you could reduce your tax rate from 50% to as low as 4%—or even 2%—on export services, and pay 0% on capital gains? Víctor explains how relocating to Puerto Rico offers physicians practicing telehealth unprecedented opportunities to build wealth rather than surrender it to excessive taxation.

The conversation explores Puerto Rico's distinct tax incentives for both business owners and investors, compliance requirements including the six-month residency rule, and the critical importance of working with strategists who understand both U.S. and Puerto Rico tax law. Víctor shares compelling success stories, including one client who recovered $800,000 in overpaid taxes. They discuss the holistic planning approach necessary for a smooth transition, emerging trends in global tax mobility, practical considerations for establishing a medical practice in Puerto Rico, and why proper guidance makes all the difference in maximizing these life-changing opportunities.

Víctor Delerme, CPA, is the founder of Delerme CPA, a boutique tax advisory firm specializing in Puerto Rico's Act 60 incentives with offices in San Juan, Miami, and Atlanta. Licensed in both Puerto Rico and Georgia, Víctor leverages over 16 years of experience helping physicians, entrepreneurs, and high-income earners keep more of what they earn through strategic, compliant tax planning. After beginning his career at KPMG and working with regional firms in Atlanta, he identified a critical gap in personalized tax strategy and built a team of 30+ professionals dedicated to export service optimization, capital gains planning, cryptocurrency strategies, and international tax structuring. What sets Víctor apart? His holistic approach combines deep expertise in both U.S. and Puerto Rico tax law with genuine understanding of each client's financial goals and lifestyle, ensuring seamless transitions that transform tax burdens into wealth-building opportunities.

In This Episode:

• (00:00) How high-income physicians can reduce tax rates from 50% to as low as 4% or even 2%
• (05:00) Puerto Rico's dual tax incentives: 4% on export services and 0% on capital gains
• (10:41) Compliance requirements, the six-month residency rule, and addressing audit concerns
• (16:07) Success story: How one client recovered $800,000 in overpaid taxes
• (22:07) First steps for business owners considering relocation to Puerto Rico
• (27:19) Establishing a medical practice in Puerto Rico and understanding the market
• Share with a dermatology pro you know, like and subscribe to hear all of our future episodes!

About the show: Welcome to Skin Deep, a podcast designed for dermatology professionals. Host Dr. Anna Chacon, a distinguished dermatologist and author, shares her unique experiences and offers valuable insights on the future of dermatology, including telemedicine and teledermatology in reaching underserved communities. Dr. Chacon provides actionable recommendations for dermatology practices, emphasizing compassion, patient education, and staying current with advancements in the field.

About the host: Dr. Anna Chacon, board-certified dermatologist and founder of Indigenous Dermatology, specializes in treating patients...

• (00:00:00) - CPA Victor Delerme on Puerto Rico Taxes
• (00:02:32) - Don't Overpay Taxes
• (00:05:04) - Puerto Rico tax incentives for doctors and business owners
• (00:12:49) - Are Tax Aspirations Common in Puerto Rico?
• (00:14:24) - How do you approach the Puerto Rico tax incentive?
• (00:16:03) - Tax Success Story
• (00:18:26) - Starting a firm after earning your CPA
• (00:20:22) - How to Prepare and Prepare Tax Returns in Puerto Rico
• (00:23:32) - What trends do you see in global mobility taxation?
• (00:24:57) - MDs on the Cost of Relocating to Puerto Rico
• (00:29:08) - What is the youngest person you have helped?

“Even when the system seems unbeatable, persistence, evidence, and truth can prevail.” - Dr. Rifai

Dr. Anna Chacon, board-certified dermatologist and host of Skin Deep, welcomes Dr. Muhamad Aly Rifai — triple-board-certified in internal medicine, psychiatry, and addiction medicine. A genuine telehealth pioneer since 2006, Dr. Rifai helped build the nation's first emergency telehealth system and co-authored the field's early clinical guidelines. What does it cost to be ahead of your time? He knows firsthand. His book, Doctor Not Guilty, hit number one on Amazon in mental health and health law. His core message: impeccable documentation isn't just best practice — when the government comes knocking, it becomes your entire defense.

The episode covers every stage of Dr. Rifai's seven-year ordeal: a Medicare audit in 2017, a federal indictment in 2022, and a five-day trial in May 2024 that ended with a "not guilty on all charges" verdict in just two hours. Can one physician really beat the Department of Justice? Dr. Rifai walks through the investigation tactics physicians rarely see coming — secret bank access, four consecutive IRS audits, staff intimidation. He also spotlights landmark physician cases, including one now petitioned to the U.S. Supreme Court, and resources for doctors who need support today.

Dr. Muhamad Aly Rifai is board-certified in internal medicine, psychiatry, and addiction medicine, with over 15 years in private practice. A telehealth pioneer since 2006, he helped establish the nation's first emergency telehealth system and authored foundational guidelines for the field. In May 2024, he was acquitted on all counts of federal healthcare fraud following a landmark five-day trial. His memoir, Doctor Not Guilty — a number one Amazon bestseller in mental health and health law — chronicles that journey. He now advocates for physicians facing legal challenges through www.shield.expert.

In This Episode:

• (00:00) Dr. Rifai shares his telehealth career and the book that came from his legal fight
• (06:36) Inside the investigation: how a 2017 Medicare audit became a federal indictment
• (12:54) Other physicians who fought back — and the case now before the Supreme Court
• (17:00) How Dr. Rifai protected 20,000 patients' trust and fought back through the media
• Share with a dermatology pro you know, like and subscribe to hear all of our future episodes!

About the show: Welcome to Skin Deep, a podcast designed for dermatology professionals. Host Dr. Anna Chacon, a distinguished dermatologist and author, shares her unique experiences and offers valuable insights on the future of dermatology, including telemedicine and teledermatology in reaching underserved communities. Dr. Chacon provides actionable recommendations for dermatology practices, emphasizing compassion, patient education, and staying current with advancements in the field.

About the host: Dr. Anna Chacon, board-certified dermatologist and founder of Indigenous Dermatology, specializes in treating patients in remote and rural communities. As the first dermatologist serving Alaska's Bush region, she travels by bush plane to reach isolated communities. Dr. Chacon holds medical licenses in all 50 states, DC, Guam, and the U.S. Virgin Islands, providing both in-person and teledermatology services.

Resources:

Dr. Muhamad Aly Rifai:

Website: www.alyrifai.com

Practice (Blue Mountain Psychiatry): www.bluepsychiatry.org

LinkedIn: www.linkedin.com/in/alyrifai

SHIELD — Support and Help in Ethical Legal Defense:

• (00:00:00) - Dr. Muhammad Ali Refai on Trial for Healthcare Fraud
• (00:06:55) - Ex-Telehealth Employee Accused of Fraud
• (00:11:34) - Viraj Gupta on the IRS Audit
• (00:14:57) - The COVID Pandemic physician case
• (00:17:28) - Physicians facing criminal prosecutions

What drives a surgeon to leave the operating room?

Dr. Anna Chacon welcomes Dr. Samuel Sarmiento, a physician-turned-strategy consultant who transformed his medical career into entrepreneurial success. Dr. Sarmiento, founder and CEO of Juniper Life Sciences, brings a unique blend of surgical training from Mayo Clinic and dual graduate degrees from Johns Hopkins University in public health and business administration. His boutique consulting firm specializes in health, wellness, and digital health companies, from supplement brands to biotechnology startups. Dr. Sarmiento's journey reveals the importance of aligning professional choices with personal values and recognizing burnout before it takes hold.

This conversation explores the critical decision points facing physicians considering non-traditional career paths. Topics include the practical value of MPH and MBA degrees for healthcare professionals, strategies for physicians experiencing burnout, and the role of self-reflection in career transitions. Dr. Sarmiento shares his passion for language learning—he speaks seven languages—and discusses how it enhances cultural competence and business relationships. The episode also addresses emerging trends in healthcare, particularly artificial intelligence's potential to reduce administrative burden and improve patient care, while maintaining the irreplaceable human element of medicine.

Dr. Samuel Sarmiento is a physician-turned-strategy consultant specializing in health, wellness, and digital health sectors. Originally from Ecuador, he completed his surgical internship at Mayo Clinic before earning dual graduate degrees in Public Health and Business Administration from Johns Hopkins University. He founded Juniper Life Sciences, a boutique consulting firm helping companies innovate through strategic consulting and clinical research. A polyglot speaking seven languages, Dr. Sarmiento is exploring AI's role in reducing physician burnout and envisions creating a holistic healing center in Ecuador integrating physical, mental, and spiritual wellness.

In This Episode:

• (00:00) Dr. Samuel Sarmiento shares his path from Ecuador to Mayo Clinic and discovering consulting wasn't the right fit
• (03:14) Family influence and maintaining cultural identity while building a career in the United States
• (05:52) The real value of public health and business degrees for physicians considering entrepreneurial paths
• (10:36) Language learning as a tool for cultural competence and enhanced business relationships
• (15:42) Essential advice for physicians considering entrepreneurship or experiencing clinical burnout
• Share with a dermatology pro you know, like and subscribe to hear all of our future episodes!

About the show: Welcome to Skin Deep, a podcast designed for dermatology professionals. Host Dr. Anna Chacon, a distinguished dermatologist and author, shares her unique experiences and offers valuable insights on the future of dermatology, including telemedicine and teledermatology in reaching underserved communities. Dr. Chacon provides actionable recommendations for dermatology practices, emphasizing compassion, patient education, and staying current with advancements in the field.

About the host: Dr. Anna Chacon, board-certified dermatologist and founder of Indigenous Dermatology, specializes in treating patients in remote and rural communities. As the first dermatologist serving Alaska's Bush region, she travels by bush plane to reach isolated communities. Dr. Chacon holds medical licenses in all 50 states, DC, Guam, and the U.S. Virgin Islands, providing both in-person and teledermatology services.

Resources:

Website: jun...

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• (00:02:07) - What was it that made you think that you didn't want that
• (00:03:22) - Dr. Junipero Serra on His Family and Juniper
• (00:06:00) - Post-Post-Bacc MS in Business and Public Health
• (00:08:26) - What are some of the biggest challenges facing your practice?
• (00:09:49) - Teaching Yourself Five Languages As an Adult
• (00:14:14) - Are You More Productive As an Entrepreneur?
• (00:15:51) - What advice would you give to physicians considering a transition into entrepreneurship,
• (00:18:02) - In the Elevator With Dr. Remarkable