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FISCHER v. UNITED STATES

Opinion of the Court

bursements received for depreciation costs and other cash
into sinking funds called “funded depreciation accounts.”
§ 413.134(e).
Investment income earned on these funds does
not operate to reduce a provider’s interest expense,
§ 413.153(b)(2)(iii), creating incentives to maintain modern
medical equipment and facilities.

The Medicare regulations, furthermore, afford certain pro-
vider organizations “special treatment,” intended to ensure
the ongoing availability of medical services for qualifying
patients. See 42 CFR pt. 412G (1999). Providers qualify-
ing as “Medicare-dependent, small rural hospital[s],” for in-
stance, are entitled to additional, “lump sum” payments to
compensate for signiﬁcant declines in demand for patient
care.
§ 412.108. The additional funds enable a provider to
“maintai[n] [its] necessary core staff and services” and to sat-
isfy its “ﬁxed (and semi-ﬁxed) costs.” §§ 412.108(d)(3)(A),
(B). So too does the Medicare program authorize “special
treatment” for, among other providers, “sole community hos-
pitals,” “renal transplantation centers,” and “hospitals that
serve a disproportionate share of low-income patients.” See
§§ 412.92, 412.100, 412.106. The subsidies assist providers in
satisfying those ﬁnancial obligations necessary to continue as
going concerns in accordance with the program’s require-
ments. See, e. g., § 412.92(d)(2).

In the normal course Medicare disbursements occur on a
periodic basis, often in advance of a provider’s rendering
services, 42 U. S. C. § 1395g(a); 42 CFR §§ 413.60, 413.64
(1999). The payment system serves to “protect providers’
liquidity,” Good Samaritan Hospital v. Shalala, 508 U. S.
402, 406 (1993), thereby assisting in the ongoing provision of
services.
42 CFR § 413.5(b)(1) (1999) (requiring reimburse-
ment method to “result in current payment so that institu-
tions will not be disadvantaged, as they sometimes are under
other arrangements, by having to put up money for the pur-
chase of goods and services well before they receive reim-
bursement”); § 413.5(b)(6) (reimbursement system must oper-