It seemed like a golden opportunity. A small pink-sand island, just off the US coast, with too few people to support a full team of medical specialists, but enough health problems — cancer, diabetes, obesity, and other serious diseases — to require high-level care.
During a chance encounter years ago, a Bermudian doctor, Ewart Brown, floated the idea to a physician from Lahey Clinic, suggesting that the hospital could expand its business while filling a pressing health need.
The Burlington hospital now sends a rotating group of 25 cardiologists, neurologists, orthopedists, and other specialists to Bermuda, where they stay in hotels and treat patients referred by local doctors.
Lahey is one of several US hospitals that provide specialty care on the British territory — a successful venture that on Tuesday put Lahey at the center of a federal bribery lawsuit over its relationship with Brown.
Lahey does not own facilities on the island but rents space in doctors’ offices and at the state-run King Edward VII Memorial Hospital. It used to also see patients in two clinics owned by Brown.
About 10 Bermudian patients a week travel to Lahey for heart surgery, knee replacements, and other more complex care.
“There are significant chronic health issues there,’’ said Lahey spokesman Christopher Murphy. “We have a constant presence on the island.’’
Since Lahey said it became the first US hospital to bring medical care to Bermuda more than two decades ago, many others have seized business opportunities overseas, from Bermuda and the Caribbean to the Middle East and Asia.
Countries with growing middle classes, such as China, are racing to build up their health care systems and often want to team up with top-tier American hospitals, which they consider the world’s best.
But few of these relationships have come under the scrutiny Lahey now faces. A federal lawsuit filed Tuesday by the Bermuda government accused the hospital of bribing Brown, who was the island’s premier from 2006 to 2010, in order to secure health care business there — a suit Lahey said Wednesday was motivated by internal island politics, not its business practices.
The lawsuit asserts that the hospital and Brown were part of a sweeping racketeering conspiracy that spanned 20 years and involved money laundering, mail fraud, and corruption. In return for bribes disguised as consulting fees, the lawsuit claims, Brown directed a huge share of the island’s health care business to Lahey, including lucrative contracts to interpret thousands of MRIs and CT scans performed at two clinics owned by Brown.
The lawsuit alleges that some of these scans were not medically necessary and led to Bermudians being some of the most heavily scanned people in the world.
Lahey still provides tele-radiology services to Brown’s clinics, but said the consulting relationship ended in 2015. The hospital also interprets scans and provides other remote medical care to patients at the government-owned hospital.
Brown, who attended medical school and initially practiced medicine in the United States, returned to Bermuda in 1990, the suit says. He then entered politics.
Lahey began sending doctors to Bermuda to treat patients at one of his clinics in 1997, and by 2001, the hospital was paying him as a consultant to promote its interests on the island, the lawsuit says. It alleges that Brown lobbied the government for fee increases for imaging tests performed in Bermuda that Lahey interpreted remotely in Massachusetts, and to give Lahey a foothold at the hospital.
On Wednesday, Lahey said it believes the lawsuit “is likely motivated by internal island politics,’’ as the current government tries to discredit its political opposition in an election year.
“We are committed to defending this lawsuit and to ensuring this political conflict does not prevent our patients from getting the care they need and deserve,’’ Murphy said.
The lawsuit is a civil suit, but it asserts that Lahey violated criminal laws including those that forbid US businesses from paying foreign officials to further their profits.
But Murphy said that the hospital’s “Bermuda business contracts and consulting agreements have been thoroughly reviewed by internal and external parties — all of whom have found our practices to be fully compliant with all applicable laws and regulations.’’
International business deals are nothing new for American hospitals.
Some of the country’s top medical systems, such as Partners HealthCare of Boston, Johns Hopkins Medicine in Baltimore, and the Cleveland Clinic, have business relationships overseas. These can range from consulting and training agreements, to affiliations that allow American doctors to work in hospitals abroad, to arrangements that have American hospitals building their own facilities overseas.
Lately, American hospitals have been targeting countries in Asia and the Middle East, where large and wealthy populations are demanding better medical care.
Such deals are appealing to organizations, such as Partners, which have limited room to grow locally.
“This is about taking the truly special skills of the people who work inside our system and making them available to others around the world,’’ said Christopher Coburn, Partners’ chief innovation officer who oversees the company’s international projects.
Coburn said that American companies commonly employ staff or outside consultants to help them “navigate the very complex systems’’ of health care in other countries.
Like Lahey, the Partners teaching hospitals, Massachusetts General and Brigham and Women’s, have strong ties to Bermuda, going back about 15 years. Brigham, with the Dana-Farber Cancer Institute, is developing a radiation therapy program in Bermuda, a response to the fact that cancer patients have had to leave the island for treatment.
Boston, just a two-hour flight from Bermuda, is also a destination for patients from the island who need specialized care. As of 2015, Bermuda was the top country of origin for international patients at the Brigham. Mass. General also treats many people from the island.
“Patients have been coming to our hospital from Bermuda for decades because of our commitment to providing world-class medical care as well as our accessibility and close proximity to the island,’’ hospital senior vice president Greg Pauly said in a statement.
Boston Children’s Hospital also has longstanding relationships in Bermuda and sees many patients from the island in Boston.
Lahey executives are likely to devote time and money fighting the Bermuda government’s lawsuit, at the same time it negotiates a merger with Boston’s Beth Israel Deaconess Medical Center.
Jennifer Kritz, a spokeswoman for Beth Israel Deaconess, said the discussions are continuing. “We have just become aware of the lawsuit and will review it carefully as part of our due diligence process,’’ she said in an e-mail. Beth Israel Deaconess does not have any business deals in Bermuda, she said.
Liz Kowalczyk can be reached at kowalczyk@globe.com. Priyanka Dayal McCluskey can be reached at priyanka. mccluskey@globe.com.
