Defendants Dr. Ronald LaHue and Dr. Robert LaHue, agents of Blue Valley Medical Group (BVMG), were indicted on one count of conspiracy under 18 U.S.C. § 371 (count 1), seven counts of Medicare fraud under the Anti-Bribery Act, 18 U.S.C. § 666(b) (counts 2 through 8), one count of conspiracy under 18 U.S.C. § 286 (count 9), and one count of witness tampering under 18 U.S.C. § 1512 (count 10). The district court granted defendants’ motion to dismiss counts 2 through 8 on the theory that BVMG did not receive federal benefits as required by section 666(b) and therefore was not within the ambit of the statute.
1
United States v.
Lu-
*1027
Hue,
I
From 1985 to 1995, BVMG provided services in Kansas and Missouri as one of the largest geriatric care practices in the United States. Dr. Robert LaHue was president of BVMG and his brother, Dr. Ronald LaHue, was vice-president. The LaHues and other BVMG physicians provided medical services to nursing home residents and also referred patients to various hospitals for inpatient and outpatient care.
The indictment alleged that the LaHues engaged in a criminal scheme to receive bribes from various hospitals in return for referring Medicare patients to the hospitals. It asserted that the LaHues proposed and entered into a number of sham consulting agreements where BVMG received annual consulting “fees” from each hospital in amounts ranging from $50,000 to $150,000 in return for referring patients to the paying hospital. The government charged that the scheme constituted federal government program fraud in violation of section 666, which applies to an organization that receives “benefits” under a federal program.
The LaHues moved to dismiss the charges of program fraud, asserting that Medicare reimbursements to doctors are not benefits within the meaning of section 666(b). The district court agreed. The court determined that Medicare payments are extended by Congress to the patient, who is both the intended recipient of the funds and the intended beneficiary of Medicare. The patient is permitted voluntarily to direct the funds to the medical provider through assignment. Under this pattern of disbursement, the district court held that reimbursements to BVMG physicians can not be characterized as section 666 benefits from, a federal program because those benefits were disbursed to the patient before dissemination to BVMG. Accordingly, the district court dismissed the claims against BVMG under section 666. 2
II
In reviewing the district court’s determination, we must decide whether providers of medical services to Medicare Part B patients fall within the statutory jurisdiction of 18 U.S.C. § 666(b). In other words, are the LaHues agents of an organization, BVMG, that “receive[d] benefits in excess of $10,000 under a Federal Program.” Id. (emphasis added) In making this determination, we look first at the nature of the Medicare program, and then assess section 666 in light of that program.
A. Medicare Part B
Many BVMG patients were eligible for Medicare reimbursements under 42 U.S.C. §§ 1395j-1395k and used the reimbursements to pay for BVMG services under Medicare Act Part B. The Medicare Act consists of two parts: Part A, Hospital Insurance Benefits for the Aged and Disabled, 42 U.S.C. §§ 1395c — 1395i; 3 and Part B, Supple *1028 mentary Medical Insurance Benefits for the Aged and Disabled, 42 U.S.C. §§ 1395j-1395w. Our case exclusively addresses Medicare Part B payments. Part B of the Medicare system was established to provide “benefits” to the individual beneficiary for use in paying the costs of certain medical services, including physicians’ services. Part B is a voluntary program where beneficiaries pay monthly premiums that, along with federal government contributions, are remitted to the Federal Supplementary Medical Insurance Trust Fund. See id. § 1395t. The Department of Health and Human Services has responsibility for administering the program and contracts with private insurance carriers who evaluate and pay Part B claims out of the Trust Fund. See id. § 1395u.
Under Part B, a physician may either request direct payment by patients on the basis of an itemized bill or accept assignment agreements. Under an assignment agreement, the beneficiaries execute formal assignments of their individual benefits to the physicians to compensate the physicians for health care services. See id. § 1395u(h). A physician who does not accept assignment can charge her patient in excess of the Medicare allowed expense, a practice called “balance billing.” Medicare pays eighty percent of reasonable reimbursable claims while the beneficiary is responsible for the remaining twenty percent and any “balance billing.” See 42 U.S.C. § 1395Í. The dismissed charges at issue here all involved patient assignments directing that their Medicare reimbursements be sent to the BVMG physicians to pay for medical services rendered. A BVMG physician who accepted assignment agreed to accept a specified amount as full payment for each service. This assignment scheme implies that the intended beneficiary of Medicare Part B is the patient. The Medicare statute reinforces this interpretation. It provides in relevant part:
Scope of benefits; definitions
(a) The benefits provided to an individual by the insurance program [Medicare] established by this part shall consist of—
(1) entitlement to have payment made to him or on his behalf (subject to the provisions of this part) for medical and other health services....
42 U.S.C. § 1395k. As the statute reads, “benefits” are “provided to an individual,” who has the authority to direct whether they are to be paid “to him or on his behalf.” Id. With this in mind, we turn to an analysis of section 666.
B. 18 U.S.C. § 666
We review legal issues of statutory construction de novo.
United States v. Oberle,
The Anti-Bribery Act, 18 U.S.C. § 666, prohibits the unlawful acceptance of anything of value of $5,000 or more if the person taking the bribe is an agent of an organization subject to the statute. Whether an organization falls within the scope of the statute is determined pursuant to the limits of section 666(b), which reads:
The circumstances referred to in subsection (a) of this section is that the organization, government, or agency receives, in any one year period, benefits in excess of $10,000 under a Federal program involving a grant, contract, subsidy, loan, guarantee, insurance, or other form of Federal assistance.
*1029
18 U.S.C. § 666(b). The district court acknowledged the superficial appeal of the government’s contention that the plain language of section 666(b) includes the patient assignments to BVMG.
See LaHue,
In support of this argument, the government offers an analogy to anti-discrimination statutes, contending that “section 666 ‘expressly equates “benefits” with “Federal assistance.’”” Br. of Aplt. at 15 (quoting
United States v. Rooney,
We are not persuaded by the analogy to anti-discrimination statutes, which are civil rather than criminal. We must exercise particular restraint in interpreting federal criminal statutes.
Dowling,
Finally, like the district court, we believe that a closer look at the government’s position reveals ambiguity in the plain meaning of section 666. Under the government’s interpretation of section 666(b), any organization that is assigned $10,000 in a year in funds initially disbursed under a federal program source would fall within the statute. Thus, when funds have passed to the beneficiary and she assigns the funds further to any number of organizations which may assign them even further, the government’s theory suggests that these monies are all considered benefits as long as they originated under a federal benefits program. Presumably under this interpretation, if the recipient physician endorsed Medicare checks to pay a supplier of medical goods, the supplier would be receiving benefits from a federal program. As the district court aptly noted, this construction creates almost a limitless statutory reach beyond a plain commonsense interpretation of the statute.
See LaHue,
Like other courts that have wrestled with an interpretation of section 666(b), we look to the legislative history and the underlying purpose of the statute for guidance.
See United States v. Copeland,
to prevent diversions of federal funds not only by agents of organizations that are direct beneficiaries of federal benefits funds, but by agents of organizations to whom such funds are ‘disbursed’ for further ‘distribution]’ to or for the benefit of the individual beneficiaries.
United States v. Zyskind,
When Congress enacted section 666, it cited three cases that represent the types of situations section 666 was intended to cover.
See
S.Rep. No. 95-225, at 370 nn. 2 & 3,
reprinted in
1984 U.S.C.C.A.N. at 3182, 3511 nn. 2 & 3;
see also Salinas,
552 U.S. at -,
The purpose of section 666 to prevent the diversion of federal program funds on the distribution path to the intended beneficiaries is fulfilled once the funds have been received by the actual beneficiary. Cases interpreting section 666(b) support this conclusion. In
U.S. v. Wyncoop,
In both Wyncoop and the instant case, the beneficiary had discretionary rights to the money. Although the court in Wyncoop did not emphasize the fact, we believe it was important to the outcome of the case that the checks were issued either to the students or jointly to the students and the school. The loans were thus made to the students and passed on to the college in the form of tuition payments. As such, the court’s ultimate determination that the college did not receive “benefits” within the meaning of section 666(b) is consistent with our conclusion in this case. Here, the private insurance company administering the Medicare benefits issued a check to the BVMG physician only after an assignment of the fees by the patient to the physician.
In
U.S. v. Zyskind,
Zyskind is distinguishable from the instant case. There, Hi-Li received the money directly and was charged with a fiduciary responsibility to use the money for the bénefit of the intended beneficiary, the resident. True to the purposes of section 666 to protect federal funds enroute to the beneficiary, the court upheld section 666 coverage over Hi-Li. By contrast, BVMG was merely accepting each patient’s payment by voluntary assignment for services already rendered. BVMG had no power or duty to administer or disburse the funds further to the benefit of its Medicare patients. 7
We conclude that Congress intended the reference in section 666(b) to an organization receiving federal program benefits to mean one that receives benefits before final distribution to the intended beneficiary, here the patient. What happens to the funds once the patient receives them is beyond the scope of section 666. Thus, any assignment of such funds to a third party does not constitute a receipt of federal program benefits within the reach of section 666. We are not persuaded it was Congress’s intent in enacting section 666(b) to follow the intended beneficiaries’ further distribution of the federal *1032 benefits. As a result, we hold that BVMG falls outside the scope of section 666.
We AFFIRM the district court.
Notes
. Section 666 provides in relevant part:
(a) Whoever, if the circumstance described in subsection (b) of this section exists— ll) being an agent of an organization, or of a State, local, or Indian tribal government, or any agency thereof—
*1027 (B) corruptly ... accepts or agrees to accept, anything of value from any person, intending to be influenced or rewarded in connection with any business, transaction, or series of transactions of such organization, government, or agency involving anything of value of $5,000 or more;
shall be fined under this title, imprisoned not more than 10 years, or both, (b) The circumstance referred to in subsection (a) of this section is that the organization, government, or agency receives, in any one year period, benefits in excess of $10,000 under a Federal program involving a grant,contract, subsidy, loan, guarantee, insurance, or other form of Federal assistance.
18 U.S.C. § 666(a, b).
. After the dismissal, the government impaneled a new grand jury that indicted the LaHues for the same alleged conduct under an anti-kickback statute, 42 U.S.C. § 1320a-7b, which criminalizes the acceptance of bribes for Medicare patient referrals.
. Part A concerns institutional health providers (hospitals, nursing homes, rural health clinics) and is funded out of Social Security taxes. Payment by Medicare under Part A for services rendered by a hospital or other institution may *1028 only be made to the institution, and the institution may not bill the patient directly, except for deductibles and coinsurance. Part A is not implicated under the government’s theory in this case.
. We note in this regard that in United States v. Baylor Univ. Med. Ctr., 736 F.2d 1039 (5th Cir.1984), the court expressly grounded its holding on the legislative history of the anti-discrimination statutes, judicial decisions construing them, and regulations adopted under them. See id. at 1042.
. We note that § 666(c) refines § 666(b) by carving out certain transactions in the ordinary course of business: "This section does not apply to bona fide salary, wages, fees, or other compensation paid, or expenses paid or reimbursed, in the usual course of business.” 18 U.S.C. § 666(c).
Cf. United States v. Copeland,
. In
New York Conference of Blue Cross v. Travelers Ins. Co.,
The governing text of ERISA is clearly expansive. Section 514(a) marks for pre-emption "all state laws insofar as they ... relate to any employee benefit plan” covered by ERISA, and one might be excused for wondering, at first blush, whether the words of limitation ("insofar as they ... relate”) do much limiting. If “relate to" were taken to extend to the furthest stretch of its indeterminancy, then for all practical purposes pre-emption would never run its course, for "frfeally, universally, relations stop nowhere," H. James, Roderick Hudson xli (New York ed.. World’s Classics 1980). But that, of course, would be to read Congress’s words of limitation as mere sham....
Id.
at 655,
. The government argues that "basing statutory coverage on whether federal payments are for past or future services ... has been rejected as ‘frivolous.’ ” Br. of Aplt. at 20 (citing
Baylor University,