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The settlement of the civil charges still needs formal approval from the Justice Department and courts. But it would bring to $1.7 billion the amount HCA has paid or agreed to pay the government in civil fines and criminal penalties in recent years.

Whistle-blowers accused HCA of filing false claims for reimbursement from Medicare and Medicaid and paying kickbacks to doctors so they would refer patients to its hospitals.

Under the settlement, HCA, which operates 180 hospitals in 23 states and England and Switzerland, did not admit to any wrongdoing.

"We are pleased to have successfully negotiated a settlement to the remaining two civil issues," said Jack O. Bovender, Jr., HCA chairman and chief executive.

James Thompson, a Texas doctor who filed a whistle-blower suit in 1995 alleging kickbacks and Medicare fraud, said the case cost him his health and his practice. He said other doctors ostracized him, so he practiced alone without a day off for three years, suffering a stroke in 1998.

"I said it then, and I'll say it again: Doctors have a duty to protect the health of the community. They protect their patients first, and profits last," Thompson said. "I am proud of what I did, and I'd do it again. But I'm sure glad it's over."

However, attorneys representing other whistle-blowers were not ready to sign off on the settlement. The government has not detailed how the money will be split up or how much will go to the whistle-blowers.

HCA pleaded guilty in 2001 to defrauding government health care programs and paid $840 million that year in fines and settlements.

In the only case to go to trial, two former HCA executives -- Jay Jarrell and Robert Whiteside -- were convicted in 1999 of conspiring to defraud the government and making false statements with regard to a hospital in Port Charlotte, Fla. The convictions were overturned this year on appeal.

Wall Street liked the news. HCA shares rose 3.4 percent, or $1.39 a share, to close Wednesday at $42.90 on the New York Stock Exchange.

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