Teva listed the payments as sales/marketing expenses, and as consultancy fees, which were then paid for by the Ukrainian state by means of inflated invoices. That in turn left less money in the budget to pay doctors’ salaries, or any of the other things needed to run a medical system. Those doctors were then forced to recoup their salaries and their maintenance costs at the bottom of the pyramid, from their patients. Meanwhile, at the tip of the pyramid, the management extracted the money—from Teva, or the dozens of other healthcare companies vying to sell their products in Ukraine—via their
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