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But Germany's current legal situation offers far too few possibilities to apply penalties. Last year, the European Commission gave the Federal Republic a good score on its evaluation of anti-corruption efforts in the country. Still, the first report on combating corruption criticised the lack of criminal provisions for practicing doctors (see background).

And while estimates put the cost to Canadian tax coffers at $6-$7.8 billion per year, the effect on developing countries is far greater, said Haroon Akram-Lodhi an economist and professor of international development at Trent University. "The amount of capital flight from sub-Saharan Africa is absolutely huge and it's all going into these tax havens," said Akram-Lodhi, one of the signatories of the letter. "This is reducing the ability to fight poverty on a global scale." The letter, made public on the eve of this week's global anti-corruption summit in London, calls on world leaders to act against financial secrecy both in tax havens and at home. "To lift the veil of secrecy surrounding tax havens we need new global agreements on issues such as public country-by-country reporting, including for tax havens. Governments must also put their own houses in order by ensuring that all the territories, for which they are responsible, make publicly available information about the real 'beneficial' owners of company and trusts." On Monday, Transparency International Canada issued a parallel call for the Canadian government to make its own corporate registry more transparent.

There is a pressing need for the Government of Canada to take concrete steps to address the ability of some Canadians to shield themselves, and their financial activities, from Canadian authorities," said Peter Dent, president of Transparency International Canada. "That some can rig the system to hide their wealth, whether amassed legally or not, is not merely unjust. It also masks corruption and harms global development by siphoning off revenues that could be directed to education, health care and infrastructure," Dent said in a statement. While the growing movement to crack down on tax havens has been spearheaded by the richest countries through the Organization of Economic Cooperation and Development, the negative effects of depleted government revenues hit the poorest countries the hardest. Uganda, an East African country which has often been described as a "donor darling," remains stuck in a cycle of poverty largely due to its inability to provide state services, said Akram-Lodhi.

They don't collect enough tax (because) multinational corporations evade their fair share," he said. While the U.K. government collects 25 per cent of its GDP in tax revenue, Uganda is only able to get 11 per cent, according to World Bank statistics. Instead of having to wait longer for a new subway, low tax revenue has far graver consequences in the developing world, he said. "Tax avoidance in Canada doesn't lead to people going hungry. Tax avoidance in sub-Saharan Africa leads to people dying of hunger. It's that clear," said Akram-Lodhi. "It's criminality that ruins people's lives." Another signatory of the letter, Peter Dietsch, a professor of philosophy and economics at the Université de Montréal, said the Panama Papers have "opened a window of opportunity for action." Describing the underlying conflict over tax havens as being between people who have capital and those who don't, Dietsch said anti-tax haven forces are growing.

"There's now a growing coalition of individuals without capital who pay their taxes and small and medium enterprises who don't have resources to move their assets abroad." Canadian signatories A. Haroon Akram-Lodhi, professor of international development studies, Trent University. Peter Dietsch, professor of philosophy, Université de Montréal Hashmat Khan, professor of economics, Carleton University Kiari Liman-Tinguiri, president of IEDAS Inc., Ottawa Patricia E. Perkins, professor, faculty of Environmental Studies, York University Toby Sanger, senior economist, CUPE

If convicted, SNC-Lavalin could be banned from bidding on government contracts for 10 years under Ottawa's so-called integrity framework. The code's regulations deal with companies convicted of crimes in Canada or abroad and the ban extends to subsidiaries and sister companies of convicted companies. Three Canadian companies have been convicted since 2013 under the Corruption of Foreign Public Officials Act. Calgary-based oil and gas company Griffiths Energy International was fined $10.35 million in 2013 for bribing a diplomat's wife to secure oil rights in Chad. Niko Resources of Calgary was fined $9.5 million in 2011 for bribing a Bangladesh cabinet minister for natural gas drilling rights. Hydro-Keen Group of Red Deer was fined $25,000 in 2005 for bribing a U.S. immigration officer at the Calgary airport to get workers into the United States. In October, Card said that the company could be forced to close or sell its operations if it faced criminal charges. A company vice-president later clarified that it would consider all options in deciding what is best for shareholders. SNC-Lavalin's reputation has been tarnished in recent years by charges against former employees in Libya, Algeria, Bangladesh, and in relation to a $1.3 billion Montreal hospital contract.

Several ex-officials, including former CEO Pierre Duhaime and construction vice-president Riadh Ben Aissa, face fraud charges in Canada involving $22.5 million in payments related to the hospital contract. Ben Aissa was charged in Canada after he was extradited from Switzerland where Swiss authorities had sentenced him to the 29 months he'd served in jail on fraudrelated charges relating to SNC-Lavalin's business in Libya. They also ordered him to repay millions of dollars to the company. Ben Aissa acknowledged in court that he bribed Saadi Gadhafi, son of Libya's late dictator, Moammar Gadhafi, so SNC could win contracts. Ben Aissa also admitted to pocketing commissions. SNC-Lavalin had a presence in Libya for decades with annual revenues peaking at more than $400 million. Work included the Great Man-Made River project, a plan to pump water from deep desert wells to the populated cities along the northern coast. It also built an airport in Benghazi and a jail in Tripoli.

company dismissed Messrs. Duhaime and Ben Aissa this past winter after an internal probe found they were involved in $56-million worth of untraceable payments to commercial agents for two specific projects. Mr. Ben Aissa allegedly requested the sums while Mr. Duhaime approved them.

SNC has never publicly confirmed what the projects were. Montreal's La Presse newspaper has reported that one of them is the McGill superhos-pital project and that police are focusing on $22-million in so-called "irregular" payouts authorized by SNC executives in order to win the contract.

Dr. Porter resigned last December, three months before the end of his contract, after the National Post reported on some of his outside business activities.

The McGill superhospital is one of Canada's largest public-private infrastructure projects. SNC is leading a consortium including British infrastructure investment group Innisfree Ltd. in financing and building the hospital. It will then lease the site to the Quebec government for 30 years.

Switzerland's public broadcaster reported over the weekend that prosecutors have formally indicted the businessman, alleging he helped facilitate a criminal scheme involving $139-million in payments made by SNC-Lavalin.

Menendez has claimed he and Melgen have been friends for years and that he did nothing illegal. Melgen also is charged in a separate indictment in Florida accusing him of multiple counts of Medicare fraud. Medicare is the government-funded program providing health care coverage to the elderly. A federal judge in Newark has set a trial date for October.

He became toxic in recent years, however, as questions emerged over his role in an alleged kickback scheme related to the construction of new hospital in Montreal. Dr. Porter started running the McGill University Health Centre in 2004, and was instrumental in the awarding in 2010 of a $1.3-billion contract to SNC-Lavalin to build a massive new English hospital in Montreal. In 2013, two years after he left the health centre, Dr. Porter was charged with fraud and accepting bribes by Quebec's anti-corruption unit. He kept asserting his innocence as he fought extradition and battled lung cancer in Panama, where he was arrested as he tried to leave the country in 2013.

The McGill University Health Centre refused to comment on his death on Wednesday, except to extend its condolences to Dr. Porter's family. Mr. Harper has been accused by the opposition of having lacked judgment for appointing Dr. Porter to the Security Intelligence Review Committee (SIRC), which oversees the Canadian Security Intelligence Service. When he joined SIRC, Dr. Porter received the title of privy councillor, a story he recounted with pride in his 2014 autobiography. "I was now the Honourable Arthur Porter. I received a heightened security clearance. When I die, the flag flying above Parliament will be brought to halfmast," he wrote. In his book, The Man Behind the Bow Tie, Dr. Porter said he had gone through a "full-field" security-clearance process in the United States in relation to a position with the U.S. Department of Health. He added he was surprised at the lack of due diligence to work at SIRC, where he received access to classified material. "I did not have conversations with members of CSIS. Nobody came to my home. Whether extensive investigations occurred in the background, I don't know. I certainly never heard of it," he said.

As news reports emerged on July 1 about Dr. Porter's death, some of the people who had worked with him over the years were skeptical, fearing he had pulled another one of his tricks. "He's fooled so many different people on so many different things, I don't believe anything the family says," said a member of Montreal's medical establishment. A spokeswoman for Quebec's anti-corruption unit refused to comment, stating she was awaiting official confirmation from federal officials.

In mid-afternoon, a spokesperson for Canada's Department of Foreign Affairs responded to questions about Dr. Porter's death by stating: "We are aware of the death of a Canadian Citizen in Panama. ... Due to the Privacy Act, further details on this case cannot be released." The initial announcement of Dr. Porter's death came from the coauthor of his autobiography, Ottawa journalist Jeff Todd. "While family was present in the country, he died suddenly and alone," Mr. Todd said in a statement on his website. In his book, Dr. Porter said the money from SNC-Lavalin was linked to his work on international projects, not his work on the Montreal hospital. He said he helped the firm's interests in Africa over the years, including in Libya where the company enjoyed tight connections with the Gadhafi family. "... People often muddled SNC-Lavalin's strong interest in my international skills with its bid for the hospital contract. It was an unfortunate misperception," he said.

Dr. Porter developed a friendship during his time at McGill with Philippe Couillard, who was Quebec's health minister and is now the province's Premier. "There was a period when Couillard called me every day, asking what I thought about this issue or that decision," Dr. Porter said. Mr. Couillard has since distanced himself from Dr. Porter, stating a health company they created never got off the ground.

While a view of the corpse proved sufficient to reach that conclusion, Lafrenière said digital fingerprints and DNA samples were taken that will lead to scientific tests "to eliminate all possible doubt." Porter was accused of receiving part of an alleged $22.5-million payment from SNC-Lavalin in order to rig a $1.3-billion Montreal super-hospital contract to ensure it went to the engineering giant. Lafrenière confirmed the charges against Porter, 59, will be dropped but that proceedings will continue against seven co-accused.

Porter's wife, Pamela Porter, was sentenced in December to 33 months in prison after she pleaded guilty to two counts of money laundering in connection with her husband's case. The investigators from Quebec's anti-corruption unit were granted entry to the morgue in Panama City on Monday afternoon. The alleged $22.5-million fraud has been described by a Quebec provincial police investigator as one of the largest corruption cases in Canadian history.

Porter, who vehemently denied any wrongdoing, was transferred last May to a cancer clinic where he was receiving treatment. His doctor said he'd been treating himself while imprisoned. Porter was also once appointed head of Canada's spy watchdog agency by Prime Minister Stephen Harper.

SNC-Lavalin is a Canadian company with thousands of employees. It would be tragic if a conviction against the company, or even the threat of it, were to result in what could amount to a death sentence for SNC. It is not clear that Riadh Ben Aissa, the former vice-president who is alleged to have been the most active person in corrupt transactions in Libya and other Arab countries, was part of "the directing mind and will" of SNC-Lavalin. That is the necessary element that the law requires to find that a corporation had a criminal intent comparable to that of a flesh-and-blood human being.

Prosecutors and eventually a judge will look at these matters scrupulously. But leaving aside what's before the courts, Diane Finley, the Minister of Public Works, must fix the unintended consequences of the integrity framework. That framework, offering companies no way to set things right or make amends, doesn't fit.

The standard P3 procurement process in most cases involves an independent fairness monitor to oversee the selection phase.

The allegations against Mr. Duhaime and another former SNC executive have shaken the financial community and raised questions about the P3 process,

and Ontario premier Dalton McGuinty stood before packed ballrooms and extolled the benefits of building infrastructure through private and public funding

For instance, it has been alleged that SNC Lavalin, the Quebec-based construction giant that heads the consortium awarded the contract to build the hospital as a public-private partnership, has made payments to shadowy intermediaries to win contracts in various countries where the firm is active — including the MUHC contract.

the firm hired to excavate the land at the hospital’s Glen Yard site, Louisbourg SBC SEC, was headed by construction magnate Tony Accurso, who currently faces charges of fraud, corruption, bribery and conspiracy. His firms have previously been guilty of tax evasion.

Then there is the strange case of Dr. Arthur Porter. The former chief executive officer of the MUHC could be helpful in explaining what has gone on with the hospital process, but he left the country late last year shortly after some questionable dealings of his own came to light

Further investigation into the matter by The Gazette’s Aaron Derfel has revealed a number of anomalies in the bidding process.

“If the former government and its health ministers used common sense and put their egos aside, the CHUM (Centre hospitalier de l’Université de Montréal) would be finished years ago,” the premier said.“The MUHC (McGill University Health Centre) would not be caught up in corruption scandals,” she added. “The former government ran into a wall and took Quebec with it.”

Hospitals have fixed budgets and must not run over them the way the mega-hospital has been doing, Gaétan Barrette warned. You can't just keep accepting patients and treating them once the money has run out. It won't be tolerated.

Barrette, who is a doctor himself, might not be the canniest of politicians. Usually, Canada's elected leaders at least publicly play along with the fiction that every Canadian receives proper treatment, free of charge, in a timely manner.

First, there is no "Canadian health-care system." There are a bunch of health-care systems, one per province, with all the inherent inefficiencies that suggests, partially funded by the federal government, which is supposed to oversee things, but gave up ages ago.

The Conference Board of Canada says that if you live in Ontario, you get better health care than you do if you live in Quebec, where you will pay far higher taxes.

Second, the system is somewhat corrupt; if you have influence or an elite education or some "in," you'll get better care than a fellow who doesn't.

None of that, of course, is to mention all the Canadians who head to an American city (or somewhere like India) and pay, in order to circumvent Canadian waiting lists for other procedures.

The federal government, which has been increasing its health-care transfers to the provinces by six per cent a year, wants to cut back, claiming the provinces haven't been spending it all on health care anyway.

The oldest boomers are now 70, and it's at age 75 that people really start to soak up medical care. So will the system expand to accommodate the surge in need that's coming?

Livio Di Matteo, a health-care economist at Lakehead University

Canadian law actually forbids the private purchase of medically necessary care.

But everyone knows you can pay for a private MRI scan in many parts of the country if you don't want to wait nine or 10 months or longer for one in a hospital.

And if you don't want to languish in unbearable pain, there are places in Canada where you can buy a private hip replacement or orthopedic surgery. By and large, the federal government just pretends it doesn't see.

Third, the idea we'll be cared for in our dotage is aspirational, not anchored in law.

As Di Matteo puts it: "If you are willing to let people cross the border and do it, why not give them the option in Canada, where they live" and save them the trip?

Doctors remove a cyst from a male patient's knee at the Cambie Surgery Centre, a private clinic in Vancouver that's at the centre of a landmark case before the B.C. Supreme Court. (Darryl Dyck/The Canadian Press)

Women who want to be guaranteed that their own obstetrician will be there for the delivery are encouraged to fork over anywhere from $2,000 to $10,000 in cash.

The Quebec College of Physicians waxed indignant and launched an investigation

But in the medical community, some wondered how the minister, a physician himself, couldn’t have known what they describe as an open secret.

hush-hush payments run from $5,000 to $7,000 to jump the wait list into the operating room