Back in the day, where there ever any issues with the Pro Wrestling and sports commissions concerning the fact that it held itself out to be real. The same issues concerning fixing any other sport would've applied (Betting on wrestling and so forth) and it seems everyone involved would've been in huge a legal mess if wrestling didn't come out of the closet by in the 50s.
No, because the idea that wrestling was thought of as "real" until the WWF came along is a fallacy put out by the WWF itself. There's lot of old news stories and clippings to be had from as far back as the turn of the century that show everyone was hip to the game from a very early stage and wrestling was thought of as mostly a sideshow from the Strangler Lewis era onwards. Far as I know, the only state that seriously enforced any kind of commission was Oregon, which is why WWF didn't run there for decades. Most of the other "doctors" were seemingly of the George Zahorian variety, basically bankrolled by the promoters themselves. They might have been kayfabing the fans, but I bet they were pretty open to the government in order to avoid regulation.