Document ID: ./input/supremecourt_opinions/opinions/boundvolumes/529bv.pdf
Page Number: 761.0

529US3

Unit: $U55

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686

FISCHER v. UNITED STATES

Thomas, J., dissenting

nually to individuals entitled to beneﬁts under part A or part
B of this subchapter and when an individual applies for bene-
ﬁts under part A of this subchapter or enrolls under part B
of this subchapter”); § 1395b–4(a) (“health insurance cover-
age to individuals who are eligible to receive beneﬁts under
this subchapter”); § 1395b–4(b)(2)(A)(i) (“information that
may assist individuals in obtaining beneﬁts”).
In contrast,
the Act commonly refers to “payments” to providers of medi-
cal services. See, e. g., § 1395g(a) (“no such payments shall
be made to any provider unless it has furnished such infor-
mation as the Secretary may request”); § 1395f(a) (“payment
for services furnished an individual may be made only to
providers of services”); § 1395n(a) (1994 ed. and Supp. III)
(“payment for services . . . furnished an individual may be
made only to providers of services which are eligible”).
This terminology, and the Medicare regulations deﬁning al-
lowable costs, reﬂect the fact that Medicare is a program for
providing “ﬁnancial help” to individual elderly and disabled
patients rather than to the health care providers who treat
them. Medicare’s provisions for reimbursing providers’
costs do nothing more than establish a market exchange of
payment for services, and so cannot be said to provide “bene-
ﬁts” within the meaning of 18 U. S. C. § 666(b).

II

Although the statutory provisions and regulations cited
above demonstrate that Medicare operates as a reimburse-
ment scheme with respect to health care providers, and not
as a means of providing them “useful aid” or “ﬁnancial help,”
the Court ﬁnds in the statute and regulations evidence that
health care providers are, along with the individual elderly
and disabled patients, also target beneﬁciaries of the pro-
gram.
I think that the Court’s reasoning is both unpersua-
sive and boundless; any funds ﬂowing from a federal assist-
ance program could be deemed “beneﬁts” under the Court’s
rationale, notwithstanding the Court’s concluding disclaimer