Document ID: ./input/supremecourt_opinions/opinions/boundvolumes/529bv.pdf
Page Number: 763.0

529US3

Unit: $U55

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FISCHER v. UNITED STATES

Thomas, J., dissenting

ment is, no doubt, subject to an extensive list of statutory
and regulatory requirements, not because the Government
intends to provide “beneﬁts” to the contractor, but because
the Federal Government intends to place controls on the ex-
penditure of federal dollars. See United States v. Copeland,
143 F. 3d 1439, 1442 (CA11 1998) (discussing regulatory bur-
dens on defense contractors). Similarly, private insurers no
doubt impose various requirements on those who receive re-
In requiring hospitals to meet
imbursements from them.
certain standards, the Federal Government is no different
from these private insurers, except that the Federal Govern-
ment exercises vastly greater market power.
In other
words, the imposition on health care providers of an intricate
regulatory scheme is irrelevant to the question whether
funds paid pursuant to that scheme are beneﬁts.

Third, the Court contends that some health care providers
receive “special treatment” in the form of lump sum pay-
ments designed to ensure the providers’ ability to satisfy
ﬁnancial obligations. Ante, at 674. This feature of Medi-
care is also insufﬁcient to show that any “beneﬁts” were re-
ceived by West Volusia Hospital Authority. These payments,
which are part of the prospective payment system, see
supra, at 685, are based on estimated costs of providing serv-
ices to Medicare beneﬁciaries. See, e. g., 42 CFR § 412.108
(1999). Like the standard reimbursement schemes outlined
above, this payment system does not subsidize the hospital,
it pays the hospital prospectively for performing a service.
Finally, the Court concludes, based on its observations of
Medicare, that “Medicare operates with a purpose and design
above and beyond point-of-sale patient care,” namely, “ensur-
ing the availability of quality health care for the broader
community.” Ante, at 677, 680. According to the Court,
Medicare guarantees that “providers possess the capacity to
render, on an ongoing basis, medical care to the program’s
qualifying patients.” Ante, at 680.
In other words, Medi-
care exists to guarantee patients’ access to quality medical