Paying kickbacks to doctors for referrals. Surgically implanting unneeded heart monitors. Aggravating troubled teenagers during psychiatric sessions to worsen their mental health.

Health-care providers accused of bilking taxpayers by inflating Medicare or Medicaid expenses have paid billions of dollars in settlements with the federal government over the past decade for a variety of transgressions, some of which risked patients’ lives. Now the money is flowing the other way.

Companies that settled cases involving overbilling or fraud -- among them Tenet Healthcare Corp., Universal Health Services Inc. and Beaumont Health -- received more than $36 billion in interest-free loans from a U.S. Health and Human Services Department program to help providers handle cash-flow shortages caused by the pandemic, according to data compiled by Bloomberg and Good Jobs First, a watchdog group that has been monitoring federal relief payments.

That’s more than one-third of the $100 billion distributed through the loan program. In addition, companies accused of wrongdoing got more than $20 billion in grants issued by HHS to stave off coronavirus-related losses. In most of the cases, there was no determination of liability.

Health-care companies applied for the loans based on previous Medicare billings -- the same metric many of them were accused of inflating. Grants were distributed automatically based on patient revenues.

The loans are structured as advances on future payments the companies expect to receive from the government. Borrowers have from seven months to a year to repay them without interest. The rate jumps to 10.25% afterward. Grants don’t have to be repaid.