Physical therapists challenge discriminatory Medicare rule that bars private-pay arrangements
August 13, 2025
Washington, D.C.; August 13, 2025: Physical therapist Dr. Sean Wells and the United Physical Therapy Association filed a federal lawsuit today challenging Medicare’s ban on private-pay arrangements with physical therapists. The rule forces qualified therapists to abandon patients who turn 65. The lawsuit alleges this scheme exceeds Congress’s power under the Commerce Clause and violates the constitutional rights of physical therapists.
Physicians and most medical professionals who choose not to participate in the Medicare program are allowed to offer Medicare enrollees to pay out-of-pocket. But physical therapists are uniquely singled out: Those, like Dr. Wells, who choose not to participate in Medicare cannot serve even those enrollees who would willingly pay cash for the services.
“Physical therapists are categorically banned from ‘opting out’ of Medicare and serving enrollees on a cash basis,” said PLF attorney Joshua Polk. “Meanwhile, dietitians, social workers, and marriage counselors can freely contract privately with beneficiaries who want to pay out-of-pocket. The Constitution does not give Congress the power to enact such a scheme. To the contrary, it guarantees individuals like Dr. Wells the right to equal treatment under the law. This arbitrary exclusion serves no legitimate purpose except to trap providers and patients in a broken system.”
Dr. Wells runs a mobile physical therapy practice in Florida, bringing care directly to elderly and homebound patients who struggle to reach traditional clinics. Federal law blocks him from serving Medicare beneficiaries who want to pay privately. He’s forced to turn away longtime patients simply because they aged into Medicare.
His lawsuit challenges the government’s violation of equal protection and due process rights under the Fifth Amendment as well as the Commerce Clause of the U.S. Constitution.
The case is Sean Wells and United Physical Therapy Association v. Robert F. Kennedy.
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Pacific Legal Foundation is a national nonprofit law firm that defends Americans threatened by government overreach and abuse. Since our founding in 1973, we challenge the government when it violates individual liberty and constitutional rights. With active cases in 34 states plus Washington, D.C., PLF represents clients in state and federal courts, with 18 wins of 20 cases litigated at the U.S. Supreme Court.