A federal investigation into concerns that kickbacks were influencing decisions to do hip and knee replacement surgery has led to an agreement between the government and five companies that manufacture nearly 95% the replacement joints implanted in the U.S. (http://cbs13.com/health/health_story_271065403.html). The five companies avoided criminal prosecution by agreeing to new corporate compliance procedures and federal monitoring by the Department of Justice. Authorities say that from at least 2002 through 2006 the five companies paid orthopedic surgeons exorbitant amounts of money to be consultants and exclusively use their products, but patients and hospitals were not informed of the doctors' relationships with the manufacturers.

"This investigation uncovered evidence that health care decisions were being made based on a doctor's wallet and not on a patient's well-being," said Weysan Dun, the agent in charge of the FBI's New Jersey division.

Of the five companies involved in the agreement, all but one will be paying hefty fines, which add up to $310 million. The companies include Zimmer Holdings Inc. (fined $169.5 million), Biomet Orthopedics (fined $26.9 million), DePuy Orthopaedics (fined $84.7 million), Smith & Nephew (fined $28.9 million). The fifth company, Stryker Corp., was not required to pay any money since the company voluntarily cooperated with investigators before any other company did and was able to enter into a Non-Prosecution Agreement with the government. The amounts the companies’ fines are based on market share and are part of civil settlements with the Justice Department including more monitoring, allowing them to continue to be part of Medicare reimbursements, and protecting them from any civil lawsuits based on conduct revealed in the investigation.