Allegations of bribes for sales of medical equipment have landed four of the biggest healthcare OEMs on the radar of the FBI.

The federal U.S. agency has launched an investigation to determine if Royal Philips, General Electric, Siemens, and Johnson & Johnson paid illegal kickbacks to government officials in exchange for securing contracts with public health programs across Brazil over the past two decades. Its inquiry stems from claims by Brazilian authorities that more than 20 companies may have done so as part of a “cartel” that paid bribes and charged the government inflated prices for equipment and parts, including MR systems and prosthetics.

“We are constantly sharing information with the FBI on this [medical equipment] case. They ask for documents, and we send them, and they are assisting our investigation in return,” Brazilian federal prosecutor Marisa Ferrari told Reuters, adding that the Securities and Exchange Commission was also assisting the Brazilian investigation. “We’ve received a lot of material from the Department of Justice and from the SEC.”

Word of the allegations reached authorities in plea-bargain testimonies from suspects involved in other government corruption probes, which have grown in number in the South American country over the past five years through the discovery of corruption in state institutions and private sector companies, particularly those looking to do business with foreign entities.

Those found guilty could face heavy fines and other punishments under the U.S. Foreign Corrupt Practices Act (FCPA), which makes it illegal for U.S. citizens and companies as well as foreign enterprises with securities listed in the U.S. to pay foreign officials for rights to work with a business.

While Ferrari would not confirm the names of any companies, two Brazilian investigators, on the condition of anonymity, told Reuters that J&J, Siemens, GE and Philips were under suspicion by the FBI of committing bribery in Brazil, making them the four largest multinationals to be accused. The investigators asked not to be named as they are not authorized to discuss the U.S. side of the investigation.

Siemens told HCB News it had no knowledge of the allegations. “We are not aware of any FBI investigation of the company related to cartel activity in Brazil. And of course, it is Siemens policy to cooperate with law enforcement investigations when they occur. Please understand that we cannot further comment.”

Philips reportedly disclosed the case in July 2018 in its semiannual report and later in its 2018 annual report.

“Last year, we were informed by the Brazilian authorities that Philips in Brazil and other companies in the country (approximately 30) are subjects of an investigation into the medical device industry in Brazil. We believe that any allegation against Philips relates to a period that was prior to 2011. Philips takes this matter very seriously and we are cooperating with the Brazilian authorities,” Steve Klink, head of Philips Group Press Office told HCB News. He added that “Philips has also received inquiries from certain US authorities in respect of this matter. It is not uncommon for U.S. authorities to show an interest in these matters, and it is too early to draw any conclusions. We take these inquiries seriously, and we are reviewing them.”

A GE spokesperson told HCB News that the allegations refer to the activities of Daurio Speranzini Jr., the former CEO of GE for Brazil who was arrested last July as part of a probe into a 20-year-old alleged healthcare racket that took place when he was head of Philips Medical Systems in Brazil from 2004 to 2010. It is not implicated in the charges against him.

“The allegations refer to a time period when Mr. Speranzini worked for a company unrelated to GE,” said the spokesperson. “Based on our review, we believe there is no evidence of misconduct or any indication of GE being part of this cartel. We are committed to integrity, compliance and the rule of law in Brazil and every other country in which we do business.”

The largest of any investigation so far is Operation Car Wash, involving money laundering and acts of corruption by Brazilian state-run oil company Petrobras. The scandal has since ruined a number of political leaders and businesses across Latin America, including Brazilian construction company Odebrecht SA, which was hit in 2016 by the U.S. and Brazil jointly with a $3.5 billion penalty, the largest-ever compliance penalty in the world.

Johnson & Johnson has yet to respond for comment on the allegations.