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"We are in frequent contact and continue to co-operate" with U.S. authorities, Valeant said in a written statement. "We do not comment on rumours about investigations, and cannot comment on or speculate about the possible course of any ongoing investigation. Valeant takes these matters seriously and intends to uphold the highest standards of ethical conduct." A Pearson lawyer, Bruce Yannett, declined to comment. Dan K. Webb, a lawyer for Schiller, didn't immediately comment. Spokespeople for the FBI and Preet Bharara, the U.S. attorney in Manhattan, declined to comment. Jonathan Rosen, a lawyer for Philidor, didn't respond to requests for comment.

Prosecutors are examining the actions of J. Michael Pearson, Valeant's former CEO, and Howard Schiller, the ex-CFO who became interim CEO during a medical leave by Pearson, according to the people, who discussed the confidential proceedings on the condition of anonymity. Prosecution of individual executives could go beyond just those two, one person said, adding that Philidor executives could also be charged.

While the precise contours of the government's case against Valeant aren't clear, allegations of questionable company practices have emerged in the past year as lawsuits and government investigations mounted. Pearson, the former CEO, was a key architect of Valeant's growth over the years. He stepped down from his role last spring and continues to work as a consultant to the company from a Valeant office near his home, according to the people familiar with the matter. Schiller was blamed by Valeant for "improper conduct" that led the company to restate its earnings for 2014 and 2015, an assertion disputed by Schiller. He stepped down as CFO in 2015 and left the company board this year.

U.S. prosecutors in Boston and Philadelphia are also said to be conducting separate inquiries of Valeant. Boston's investigation, according to a person familiar with the matter, focuses on Valeant's payments to charities that then helped patients make co-payments for the soaring cost of Valeant drugs, some of the most expensive on the market. The Philadelphia case is examining Valeant's billing of government health-care programs for the company's drugs, another person said. The U.S. Attorney's Office in Boston didn't respond to a request for comment. Michele Mucellin, a spokesperson for the U.S. attorney in Philadelphia, declined to comment. Valeant said in October 2015 that federal prosecutors in New York had issued subpoenas seeking information on the company's drug distribution and pricing decisions. It later disclosed an investigation by the SEC. Judy Burns, an SEC spokesperson, declined to comment. Short-sellers first raised questions about Valeant's accounting practices and relationship with Philidor a year ago. As it turned out, Valeant had offered Philidor executives tens of millions of dollars in incentives to sell its products at a time when the relationship between the companies was still secret, according to hundreds of pages of evidence released by U.S. Senate investigators this year. Though they were nominally separate companies, Valeant was Philidor's only client, a class-action lawsuit in New Jersey alleges. Valeant ultimately acknowledged its financial control of Philidor.

In February, Valeant restated its results for 2014 and 2015, disclosing it recorded $58 million in revenue from Philidor earlier than it should have.

Two major computer networks, including Quebec's medicare database, had more outside consultants than bureaucrats working on them. Last September, the anticorruption unit, known as UPAC, charged one of its own bureaucratic partners with fraud for a suspicious laptop contract.

"Rotund, funny and occasionally pompous, Dr. Porter was everyone's friend and nobody's confidante, the life of the party and an agile dancer, both in political circles and around a ballroom floor. A member of Air Canada's board of directors, he travelled the world free. His former friend Prime Minister Stephen Harper had him sworn in as a member of the Privy Council so he could serve as chairman of the Security Intelligence Review Committee, or SIRC, the country's spy watchdog agency. "And he was close to Quebec Premier Philippe Couillard, a relationship that began in 2004 when the politician, a neurosurgeon by training, was provincial health minister. Like many of Dr. Porter's friendships, theirs ended with the news of the hospital's megacost overrun and a $22.5-million fraud inquiry connected to the MUHC's decision to award the construction contract to a consortium led by the Montreal-based engineering firm SNC-Lavalin Group Inc.

""In a way, Arthur was like Icarus, who came crashing down to earth when his wax wings melted because he flew too close to the sun," Jeff Todd, an Ottawabased journalist who first met Dr. Porter in the Bahamas and co-authored the memoir, said. ""He told me that if he did anything wrong, it was to go way too fast," Mr. Todd continued. "There was never a peak he didn't want to climb and if there was a huge challenge, he always thought he would simply fly over it. But he couldn't always do that." "The first indication was in November, 2011, when the National Post revealed he had signed a commercial agreement the year before with Ari BenMenashe, a Montreal-based Israeli security consultant and arms dealer, all while he was head of both the MUHC and Canada's spy watchdog. Mr. BenMenashe was to secure a $120million grant from Russia for "infrastructure development" in Sierra Leone. In return, a company called the Africa Infrastructure Group, which was controlled by Dr. Porter's family, would manage what he wrote were "bridges, dams, ferries and other infrastructure projects" built with the Russian money.

"Within days, he was gone from SIRC. Less than a month later, he resigned from the MUHC, departing on the grounds that he had accomplished what he had set out to do in 2004: bring together a private-public partnership and get a long-dreamed-of facility built. "Unbeknownst to the public at the time, under his watch, a planned project deficit of $12million had somehow escalated to $115-million. "The following year, fraud charges were laid, but by then Dr. Porter was on to other projects and living in a gated community in the Bahamas, where he had maintained a home for years. After Interpol issued a warrant for his arrest, he and his wife, Pamela Mattock Porter, were detained June, 2013, by authorities at Tocumen International Airport in Panama City. "Despite claiming he could not be arrested because he was on a diplomatic mission for Sierra Leone, he was soon confined to overcrowded quarters in a wing reserved for foreigners in filthy La Joya prison. Toting an oxygen tank, he became known there as "Doc," ministering to inmates who included drug dealers and murderers. The man who had begun his ascent to the top as a doctor beloved by his patients would end at the bottom as a doctor beloved by his patients again.

"He was smart, perhaps too smart for his own good, and affable, with an ability to zero in on the most powerful person in the room with laser-like focus. His long-time friend and former teacher Karol Sikora, who partnered with Dr. Porter in a Bahamian medical clinic and is also the medical director of their joint private health-care company, Cancer Partners UK, said he was uncannily good at getting people together everywhere he touched down, even if they had opposing views. ""People like that are rare and they are very good at running big institutions," Dr. Sikora said. ""Arthur reached the peak of his career in 2010, when he was all glowing and bigger than sliced bread. Then it all went wrong." "Although Dr. Porter claimed the money from SNC was payment for other consulting work he'd done for them, his friend opined that the truth will probably never come out now. ""I'd like to think Arthur was never part of this monkey business, but we'll never know," he said.

"Others were not so kind. Responding to news of his death, the MUHC issued a terse statement that extended condolences to his family and offered no further comment, while Mr. Harper suspended the protocol that would have seen the Peace Tower flag fly at half-mast to mark the death of a Privy Council member. "In prison, living in unsanitary surroundings and denied proper treatment in a hospital for the cancer that many doubted he had, Dr. Porter, who leaves his father, sister, wife and four daughters, was outwardly still full of bravado until near the end. ""I just have to survive and make do," he told CBC reporter Dave Seglins in a phone interview in March that revolved around his treatment at the prison and his successful complaint to the United Nations torture watchdog that his human rights were being trampled on. ""[The] water, food, bedding and the fact that one has to urinate in a bucket shared by about 50 to 100 people ... for someone who has an illness and needs treatment, it was pretty obvious, I presume, the UN clearly found in my favour." "In addition, Dr. Porter continued, his raspy voice rising, he had not had a single court hearing in 22 months.

"I've never left here to go into the city. I have no idea what the inside of a courtroom looks like, not in Panama, Canada, the Bahamas or anywhere," he cried. "I've never been to court in my life." "In the end, though, he seemed to be aware that the stain on his reputation would not be erased, not even in death. ""My entire life has been devoted to climbing, winning and succeeding," he wrote in his memoir. "But with the end drawing near, it is inevitable that I, like anyone else, wonder if what I have accomplished truly matters. I wonder how I will be remembered." "To submit an I Remember: obit@globeandmail.com Send us a memory of someone we have recently profiled on the Obituaries page. Please include I Remember in the subject field.

"In his memoir, Dr. Porter said his life was 'devoted to ... winning.' " "Arthur Porter, left, chats with Stephen Harper at Montreal General Hospital in 2006. The Prime Minister had Dr. Porter sworn in as a member of the Privy Council.

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.

35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms

HCA’s cardiac business is extremely lucrative, and the Justice Department has requested reviews that HCA conducted that indicate some of the heart procedures at some of its hospitals might not have been necessary and resulted in unjustified reimbursements from Medicare and other insurers.

HCA decided not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance.

In one measure of adequate staffing — the prevalence of bedsores in patients bedridden for long periods of time — HCA clearly struggled. Some of its hospitals fended off lawsuits over the problem in recent years, and were admonished by regulators over staffing issues more than once.

inadequate staffing in important areas like critical care

Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.

One facility was fined $8,000 in 2008 and $14,000 last year for delaying the start of dialysis in patients, not administering physician-prescribed drugs and not documenting whether ordered tests had been performed.

Claiming he provided poor care, the other hospital did not renew Dr. Awwad’s privileges. Dr. Awwad is suing to have them reinstated.

“If you were a for-profit hospital with investors and shareholders,” said Paul Levy, a former nonprofit hospital executive in Boston unaffiliated with HCA, “there would be a natural tendency to be more aggressive and to seek more revenues.” Executives at profit-making hospitals are “judged in greater measure by profitability” than the administrators of nonprofit hospitals, he said.

some of HCA’s tactics are now under scrutiny by the Justice Department. Last week, HCA disclosed that the United States attorney’s office in Miami has requested information about cardiac procedures at 10 of its hospitals in Florida and elsewhere.

Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff

Small and nonprofit hospitals are closing or being gobbled up by medical conglomerates, many of which operate for a profit and therefore try to increase revenue and reduce costs even as they improve patient care. The trend toward consolidation is likely to accelerate under the Obama administration’s health care law as hospitals grapple with what are expected to be lower reimbursements from the federal and state governments and private insurers.

Columbia/HCA became the target of a widespread fraud investigation in the late 1990s, which led to one of the largest Medicare settlements ever.

HCA wanted to attract more patients to its emergency rooms, and it did. Annual visits climbed 20 percent from 2007 to 2011. But while emergency departments are often a critical source of patient admissions, they are frequently money-losers because many patients do not have insurance. HCA found a solution: it figured out how to be paid more for the patients it was seeing.

Nearly overnight, HCA’s patients appeared to be much, much sicker.

No one has accused HCA of up-coding, or billing for more expensive services that were not needed — one of the complaints made against it a decade ago.

The acting head of Medicare is Marilyn B. Tavenner, a former HCA executive who left there in 2005 to become the secretary of Health and Human Resources in Virginia.

Several former emergency department doctors at Lawnwood Regional Medical Center in Fort Pierce, Fla., said they frequently had felt compelled to override the screening system in order to treat patients.

When the doctors failed to meet the hospital’s goals for how many patients should be considered emergencies, “they really started putting pressure on.”

Regulators in several states have taken HCA hospitals to task over screening out patients too aggressively, including situations where the screening missed serious conditions.

“Staffing is critical,” said Courtney H. Lyder, the dean at the UCLA School of Nursing and an expert on wound care. “When you see high levels of wounds, you usually see a high level of dysfunctional staff,” he said.

HCA owned eight of the 15 worst hospitals for bedsores among 545 profit-making hospitals nationwide, each with more than 1,000 patient discharges, tracked by the Sunlight Foundation using Medicare data from October 2008 to June 2010.

an examination of lawsuits shows bedsore problems have been persistent at several HCA facilities

The hospital was cited twice by Florida regulators, in 2008 and 2010, for having inadequate numbers of nurses on its staff to oversee wound care for patients.

Former NHS hospitals, free to generate half their income from private patients, will dedicate their staff and facilities to that end, making it impossible to monitor what is public and what people are paying for.

Billing, invoicing, marketing and advertising will add between 30% and 50% to costs compared with 6% in the former NHS bureaucracy.

some of HCA's American hospitals are under investigation for refusing care and performing unnecessary investigations and treatment, including cardiac surgery. A decade ago it paid the federal government $1.7bn to settle fraud charges, while former chief executive Rick Scott – now the Republican governor of Florida – managed to avoid prosecution.

Unitedhealth, which is currently providing services to the NHS, paid hundreds of millions of dollars in settlement of mischarging allegations in the US; Medtronic paid $23.5m for paying illegal kickbacks to physicians to induce them to implant the company's pacemakers and defibrillators; GlaxoSmithKline and Abbott paid $4.5bn in fines relating to improper marketing and coercion of physicians to prescribe antidepressants and antidementia drugs respectively. Novartis, AstraZeneca, Pfizer and Eli Lilly have all paid large fines for regulatory breaches.

And more than a dozen pharmacists in Saskatchewan billed the province for one drug but dispensed an alternative in exchange for rebates and other discounts from the manufacturer.

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.