Fresenius Medical Care AG & Co., the world's largest provider of dialysis equipment and related services, has agreed to pay U.S. authorities nearly $232 million to resolve allegations that it bribed doctors and health officials in some 17 countries in order to obtain business.

The German company also agreed to hire an independent compliance monitor for two years, remove 10 employees involved in the schemes, enhance its compliance program, adopt heightened controls on selecting third-party agents and withdraw from pending public contracts potentially related to the misconduct, according to the nonprosecution agreement the company signed with the U.S. Department of Justice.

Rice Powell, CEO of Fresenius, said in a statement, “We are pleased to have concluded these investigations and to have resolved the issues that we identified and voluntarily disclosed to the U.S. authorities. Since the investigation began we have taken extensive steps to further a culture of ethical business behavior throughout the entire company and to strengthen our compliance programs and internal controls. And we will continue to do so in close cooperation with the authorities.”

Maxwell Carr-Howard, the Dentons partner who represented the company and signed the 55-page nonprosecution deal, declined to comment and said the company would decline to comment further. Fresenius, which has its North American division in Waltham, Massachusetts, admitted violations of the U.S. Foreign Corrupt Practices Act.

It also reached a settlement on the same violations with the U.S. Securities and Exchange Commission through an administrative cease and desist order.

“In many instances,” the SEC said in a statement, “senior management actively thwarted compliance efforts, personally engaging in corruption schemes and directing employees to destroy records of the misconduct.”

The SEC said the company “failed to promptly address numerous red flags of corruption in its operations that were known since the early 2000s. This includes employees making improper payments through a variety of schemes, including using sham consulting contracts, falsifying documents, and funneling bribes through a system of third party intermediaries. FMC failed to properly assess and manage its worldwide risks, and devoted insufficient resources to compliance.”

According to the documents, Fresenius admitted that, between 2007 and 2016, it paid bribes to publicly employed health and/or government officials to obtain or retain business in Angola and Saudi Arabia. It also admitted that, in Angola and Saudi Arabia, as well as in Morocco, Spain, Turkey and countries in West Africa, Fresenius knowingly and willfully failed to implement reasonable internal accounting controls over financial transactions and failed to maintain books and records that accurately and fairly reflected the transactions.

The SEC settlement said the improper conduct continued for years in Saudi Arabia, Morocco, eight countries in the West African region, Angola, Turkey, Spain, China, Serbia, Bosnia and Mexico. The company agreed to pay the SEC $147 million in disgorgement and interest.

The three-year nonprosecution agreement with DOJ calls for the company to pay a criminal penalty of $84.7 million. It said the bribery investigation began in 2012 after Fresenius self-reported violations, but the misconduct continued into 2016.

DOJ said imposing the criminal penalty was appropriate, citing the nature and seriousness of the misconduct, including: “the amount of illegal payments to foreign officials; conduct in multiple, high-risk jurisdictions; the pervasiveness throughout a business unit of the company responsible for the conduct … the continuation of unlawful conduct until 2016; and the involvement of certain high level executives.”

Because the company mostly cooperated with the investigation, DOJ said it gave Fresenius a 40 percent discount off the criminal penalty recommended by U.S. Sentencing Guidelines.

Assistant Attorney General Brian Benczkowski of the Justice Department's Criminal Division, U.S. Attorney Andrew Lelling of the District of Massachusetts, Assistant Director Robert Johnson of the FBI's criminal investigative division and special agent in charge Joseph Bonavolonta of the FBI Boston field division made the announcement.

“Fresenius doled out millions of dollars in bribes across the globe to gain a competitive advantage in the medical services industry, profiting to the tune of over $140 million,” Benczkowski said in a statement. “Today's resolution . . . reflects the department's firm commitment to both rooting out bribery and promoting the kind of effective corporate compliance programs that will prevent misconduct going forward.”