Like Part A and Social Security, their spending is determined by eligibility and payment rules and gets paid out of a trust fund (the Supplementary Medical Insurance or SMI trust fund).

FORBES: Medicare's Peculiar Budget Rules And The Fight Over Double Counting

In addition to questionable pension plans, the IRS said Alexander oversaw creation of sham welfare-benefit plans, which are similar to pensions but fund other perks such as medical insurance and death benefits.

FORBES: IRS: Those small-business pension plans were too good to be true