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So how can they bill the same if they are not as knowledgeable? So how is it fair to a patient to be billed the same amount if they are not seeing the most qualified individuals for their money?
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Lawyer here. When an expert witness testifies in a medical malpractice case, they are testifying about what the expected standard of care is in the local community. For example, a cardiologist is generally retained in medical malpractice cases against a cardiologist, and a general practitioner would be retained in a case against a general practitioner.
For this reason, an expert witness in a case against a nurse practitioner would be testifying about what the general expected standard of care is amongst nurses. What is broadly medically accurate isn't relevant. You have to show that this professional isn't providing care that meets the standard of their own profession. 
Let's say that a nurse practitioner misdiagnoses a rare disease. Certainly, a physician expert witness could testify as to what the correct diagnosis would have been. However, that physician can't testify as to whether or not your average nurse practitioner would have caught the misdiagnosis. The physician is not a nurse practitioner, has not been trained as a nurse practitioner, and does not interact with a nurse practitioner in the same way that they interact with other doctors. An expert in the field of nursing would know more about the relevant standard of care. >

Thank you for the guidance that makes since. But now in the cases of malpractice in independent practice states. A NP can bill for the same services as an MD can in some states. If they are being paid the same rate how can some NPs cannot be sued bc they dont practice medicine but nursing even though they are providing the same services as a MD? >

It's not the same services, it's just the same billing.  A nurse practitioner only has to do 500 clinical hours of learning; a physician will have done more like 10,000.  You can't really expect the nurse practitioner to know everything the physician knows, that's not a reasonable standard.