Document ID: ./input/supremecourt_opinions/opinions/boundvolumes/529bv.pdf
Page Number: 743.0

529US3

Unit: $U55

[09-26-01 13:01:09] PAGES PGT: OPIN

668

FISCHER v. UNITED STATES

Syllabus

able cost of the services actually rendered to patients, but also to en-
hance health care organizations’ capacity to provide ongoing, quality
services to the community at large.
In the normal course Medicare
disbursements occur periodically, often in advance of a provider’s ren-
dering services, in order to protect providers’ liquidity and thereby as-
sist in the ongoing provision of such services. The program, then, es-
tablishes correlating and reinforcing incentives: The Government has an
interest in making available a high level of quality of care for the elderly
and disabled; and providers, because of their ﬁnancial dependence upon
the program, have incentives to achieve program goals. Pp. 671–675.
(b) Medicare provider payments are “beneﬁts,” as that term is used
in its ordinary sense and as it is intended in § 666(b). The Court rejects
petitioner’s argument that Medicare provides beneﬁts only to the el-
derly and disabled, not to participating health care organizations.
While standard deﬁnitions of the term “beneﬁt” and provisions of Medi-
care support petitioner’s assertion that qualifying patients rank as the
program’s primary beneﬁciaries, the fact that one beneﬁciary of an as-
sistance program can be identiﬁed does not foreclose the existence of
others. Section 666(b)’s language specifying that beneﬁts can be in the
form of “a grant, contract, subsidy, loan, guarantee, insurance, or other
form of Federal assistance,” coupled with § 666(a)’s broad substantive
prohibitions, reveals Congress’ unambiguous intent to ensure the integ-
rity of organizations participating in federal assistance programs.
In
removing from the statute’s coverage any “bona ﬁde salary, wages, fees,
or other compensation paid, or expenses paid or reimbursed, in the usual
course of business,” § 666(c) does not exclude the payments here at issue
from the meaning of “beneﬁts” within § 666(b). Medicare payments are
not simply compensation or reimbursement. The payments, in con-
trast, assist the hospital in making available and maintaining a certain
level and quality of medical care in both its own interests and those of
the greater community. The provider itself is the object of substantial
Government regulation, and adequate payment and assistance to the
provider is itself one of Medicare’s objectives. Accordingly, the health
care provider is receiving a beneﬁt in the conventional sense of the term,
unlike the case of a contractor whom the Government does not regulate
or assist for long-term objectives or for purposes beyond performance
of an immediate transaction. Pp. 675–681.

(c) The Court does not suggest that federal funds disbursed under an
assistance program will result in coverage of all recipient fraud under
§ 666(b). Adopting a broad, almost limitless use of the term “beneﬁts”
would upset the proper federal balance. The statutory inquiry should
examine the conditions under which the federal payments are received.
The answer could depend, as it does here, on whether the recipient’s