The daughter of an 83-year-old stroke survivor thought she had found the answer. Her father, who suffered from dementia, had made remarkable progress in inpatient rehab, regaining the ability to walk and perform basic tasks. But once he was discharged, Medicare sent him to a home-health agency in a remote area where therapy was infrequent and poor in quality. He began to decline rapidly. Alarmed, she turned to Florida physical therapist Dr. Sean Wells, hoping he could keep her father from losing the progress he had fought so hard to gain.

But federal law made that impossible. It forbids non-Medicare participating physical therapists from working privately with patients whose care is covered by Medicare, so Wells was legally required to turn the man away. By the time Wells was finally allowed to treat him after the patient was discharged from Medicare, the damage was done. The man had lost much of his independence, requiring near-total assistance to stand or walk to the bathroom. His daughter watched in anguish as bureaucratic rules, not medical necessity, dictated her father’s care.