Dr. Sean Wells has spent more than a decade helping elderly and disabled patients in Northern Florida regain their strength, mobility, and independence. His mobile physical therapy practice brings essential care directly into the homes of people who can’t easily travel to a clinic—seniors in rural areas, patients recovering from injury, and individuals with serious illness or physical limitations.
Many of these folks aren’t just looking to recover. They’re trying to stay on their feet, stay out of hospitals, and stay in their homes. But Dr. Wells is legally barred from treating many of the patients who need him most.
The reason? They’re on Medicare.
Dr. Wells established his practice in 2011 as one of Florida’s first cash-based physical therapy enterprises, where patients pay out-of-pocket and skip the red tape of private insurance and Medicare. This increasingly popular healthcare model gives providers the freedom to tailor treatments beyond Medicare’s rigid coverage limits and gives patients greater control over their care and pocketbooks.
The Medicare Act allows most licensed providers—doctors, nurse practitioners, clinical psychologists, even social workers—to opt out of Medicare and contract privately with Medicare beneficiaries. Not physical therapists. Despite their advanced education, state licensure, and vital role in recovery and rehabilitation, PTs aren’t on the government’s opt-out permission list.
While Congress left PTs off the list, the Centers for Medicare & Medicaid Services explicitly excluded them for not meeting the law’s definition of either “physician” or “practitioner.”
The law doesn’t question safety or qualifications. It’s a bureaucratic technicality that has serious real-world consequences. Physical therapists who aren’t enrolled in Medicare’s full reimbursement system—but dare to treat Medicare patients who insist on paying cash—risk crushing fines and banishment from their profession.
The absurdity doesn’t end there. Medicare does allow physical therapists to treat beneficiaries for services not deemed medically necessary—like general strength training. But if that same patient suffers a stroke and needs clinical rehab, the therapist must stop treatment immediately, cutting off care precisely when it’s needed most.
Worse still, PTs must turn away patients who may desperately need their care. Dr. Wells has had to part ways with longtime patients simply because they turned 65 and aged into Medicare, where they’re often funneled into crowded practices with long waitlists, short coverage windows, and less personalized care. The fallout is especially severe in rural areas where therapy options are limited or nonexistent.
Medicare was never meant to be a barrier between patients and their chosen providers. By forcing physical therapists into a one-size-fits-all system—or out of it entirely—the federal government is doing just that.
Frustration over this irrational and harmful exclusion led Maryland physical therapist Dr. Scott Gardner to form the United Physical Therapy Association (UPTA) in 2024. UPTA advocates for policies that create a better healthcare environment for providers and patients, including the ability to offer the same cash-based services to Medicare patients that most other healthcare professionals can provide.
Licensed professionals should be free to serve willing patients without the threat of fines or government retaliation. And patients deserve the dignity of choosing their provider—not who Washington decides they can see. The Constitution protects the right to equal treatment under the law and the right to earn a living free from arbitrary government interference. These rights are especially important when it comes to essential healthcare.
With free legal representation from Pacific Legal Foundation, Dr. Wells and UPTA are fighting back. Their federal lawsuit challenges Medicare’s discriminatory ban on private-pay physical therapy to protect their livelihoods and broaden Americans’ access to providers who best fit their needs—not the government’s.
What’s At Stake?
- The Constitution protects the right to equal treatment before the law and the right to earn a living free from government interference. Singling out physical therapists for exclusion from Medicare’s private-pay framework undermines those rights and leaves vulnerable patients with fewer options and worse outcomes.
- Medicare patients deserve the freedom to choose their provider—even if that provider isn’t enrolled in a government program. A system that prevents highly trained physical therapists from caring for willing patients—while allowing nearly every other provider—unfairly limits physical therapists’ ability to earn a living as well as patients’ access to care.
