Medicare’s crackdown on the wheelchair industry risks putting frail elderly and disabled patients under virtual house arrest. These regulatory changes are largely in response to a high profile Nigerian scam in Houston costing CMS millions, that occurred even after The Scooter store warned regulators of an anomalous spike in sales in that market. It is always difficult for regulators to tighten up loopholes or lapses in oversight without squeezing legitimate providers in the process. Their regulatory response, which includes new coverage limits, price reductions, and increased documentation requirements are well-intentioned, but follow a pattern familiar to most physicians treating Medicare patients. They tend to shotgun the whole herd, then try to separate the sheep from the goats afterwards.

This is rationing by stealth and program design, and ironically, will ultimately cost far more money when these patients are assigned equipment designed for indoors only and in many cases inadequate to even navigate between rooms in their homes. As every doctor already knows, patients’ physical and mental health inevitably deteriorates when they lose the freedom to move about and pursue the everyday tasks the rest of us take for granted.

These changes are not a mere inconvenience for budgetary sake. They will add unnecessary pain, injury and rapid disease progression to patients already in need of mobility assistance. Patients with degenerative conditions such as multiple sclerosis, heart disease, arthritis, and other debilitating chronic diseases will end up with broken hips, bedridden, or confined to a long term care facility. More mobile patients will find their motorized chairs running out of power on sidewalks, parking lots and other more dangerous venues.

The changes also result in a hidden tax on Medicare patients who can manage to scrape up enough money to pay the difference — usually a thousand or more dollars– to get the mobility device their doctors ordered for them. Most are on fixed incomes and will not be able to afford what their hard earned tax dollars should grant them, the ability just to get around and stay healthy.