Belgian authorities are investigating allegations that surgeons received bribes to favor certain brands of medical devices, amid accusations that the practice is rife across Europe.

The Federal Agency for Medicines and Health Products (FAMHP) began its probe following detailed reports in the Implant Files, a global collaboration led by the International Consortium of Investigative Journalists that detailed poor regulatory regimes worldwide governing medical devices.

The Belgian investigation is looking into direct payments and benefits allegedly provided to doctors by medical device manufacturers and sales personnel.

“Everyone in the sector knows these practices,” one manufacturer told Lars Bové, a journalist at De Tijd, a Belgian newspaper that collaborated on the Implant Files. “An important client asked us to sponsor him … but we refused. The result? Another company took that customer from us.”

Bové was one of two journalists quizzed by FAMHP about the substance of their findings.

In the course of their investigation, ICIJ’s Belgian partners heard allegations that orthopedics – a discipline that attracts more than $200 million in payments for prosthetics each year – was particularly rife with doctors accepting bribes from manufacturers.

For example, one surgeon expressed his suspicion that some of his colleagues favored certain brands over others even when these had been shown to be less reliable in international studies. Another who had wondered why a colleague always chose a particular stent later was told that the surgeon had accepted favors from the manufacturer.

Bové said that industry figures and surgeons told him such practices were widespread across Europe but individuals were too afraid to go public.

One sales representative said that if he went public “he wouldn’t be able to sell so much as a screw the following day,” Bové said.

A top surgeon told him: “I’d be slaughtered by my colleagues if you published my name”.

It emerged in the Implant Files that 3,468 doctors, pharmacists, nurses and other health professionals shared more than $8 million (7.35 million euros) in payments from the biggest 87 implant firms operating in the Belgian market in 2017.