Document ID: ./input/supremecourt_opinions/opinions/boundvolumes/529bv.pdf
Page Number: 747.0

529US3

Unit: $U55

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FISCHER v. UNITED STATES

Opinion of the Court

care expenditures for hospital services exceeded $123 billion
in 1998, making the Federal Government the single largest
source of
funds for participating hospitals. See Cowen
et al., National Health Expenditures, 1998, 21 Health Care
Financing Review 165, 208 (Winter 1999) (Table 11). This
amount constituted 32% of the hospitals’ total receipts.
Ibid.

Providers of health care services, such as the two hospitals
operated by WVHA, qualify to participate in the program
upon satisfying a comprehensive series of statutory and
regulatory requirements, including particular accreditation
standards. Hospitals, for instance, must satisfy licensing
standards, 42 CFR § 482.11 (1999); possess a governing body
to “ensure that there is an effective, hospital-wide quality
assurance program to evaluate the provision of patient care,”
§ 482.21; and employ a “well organized” medical staff account-
able on matters relating to “the quality of the medical care
provided to patients,” § 482.22(b). Medicare’s implementing
regulations also require hospitals, among many other stand-
ards, to maintain and provide 24-hour nursing services,
§ 482.23; complete medical record services, § 482.24; “pharma-
ceutical services that meet the needs of the patients,”
§ 482.25; and organized dietary services staffed with qualiﬁed
personnel, § 482.28. The regulations go further, requiring
hospital facilities to “be constructed, arranged, and main-
tained to ensure the safety of the patient, and to provide
facilities for diagnosis and treatment and for special hospi-
tal services appropriate to the needs of the community.”
§ 482.41. Compliance with these standards provides the
Government with assurance that participating providers pos-
sess the capacity to fulﬁll their statutory obligation of pro-
viding “medically necessary” services “of a quality which
meets professionally recognized standards of health care.”
42 U. S. C. § 1320c–5(a). Peer review organizations monitor
providers’ compliance with these and other obligations.
§ 1320c–3(a); 42 CFR § 466.71 (1999). Sanctions for non-