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FROM PROPUBLICA
VA Shadow Rulers Had Sway Over Contracting and Budgeting
New disclosures and investigations are straining the three Trump associates’ relationship with the new VA secretary.
The 45th President and His Administration
Investigating Trump’s Promises to America’s Veterans
Newly released emails about the three Trump associates who secretly steered the Department of Veterans Affairs show how deeply the trio was involved in some of the agency’s most consequential matters, most notably a multibillion-dollar effort to overhaul electronic health records for millions of veterans.
Marvel Entertainment chairman Ike Perlmutter, West Palm Beach physician Bruce Moskowitz and lawyer Marc Sherman — part of the president’s circle at his Mar-a-Lago resort in Florida — reviewed a confidential draft of a $10 billiongovernment contract for the electronic-records project, even though they lack any relevant expertise.
In preparing the contract, the agency consulted more than 40 outside experts, such as hospital executives, according to the records, which were released under the Freedom of Information Act. The Mar-a-Lago trio were listed among those experts. Perlmutter, a comic book tycoon, appears on the list between representatives from the University of Washington Medical Center, Intermountain Healthcare and Johns Hopkins University.
But none of the three men has served in the U.S. military or elsewhere in government, and none of them has expertise in health information technology or federal contracting.
The list is one of hundreds of newly released documents about the so-called Mar-a-Lago Crowd’s sway over VA policy and personnel decisions. The records show them editing the budget for a government program, candidates and being treated as having decision-making authority on policy initiatives.
In a June 2017 email, a VA official identified Perlmutter alongside then-VA Secretary David Shulkin as “top principles [sic].” In another message, Moskowitz named himself, Perlmutter and Sherman to an “executive committee.”
VA Secretary Robert Wilkie has repeatedly distancedhimself from the trio. His spokesman, Curt Cashour, blamed previous leaders. “Although his predecessors may have done things differently, Sec. Wilkie has been clear about how he does business,” Cashour said in a statement. “No one from outside the administration dictates VA policies or decisions — that’s up to Sec. Wilkie and President Trump. Period.”
Secretary of Veterans Affairs Robert Wilkie at the White House on Nov. 15, 2018, in Washington, D.C. (Oliver Contreras/SIPA USA via AP Images)
But that posture carries risk for Wilkie; his predecessor was fired after losing favor with the Mar-a-Lago Crowd.
A representative of Perlmutter, Moskowitz and Sherman declined to comment, as did Shulkin and the White House.
Before they could review the government contract in March 2018, Perlmutter, Sherman and Moskowitz had to sign non-disclosure agreements, according to the newly released records. Sherman edited the agreement to allow him, Perlmutter and Moskowitz to discuss the details with one another and with the president or other administration officials, according to the emails.
The newly released emails also detail Moskowitz’s effort to get the VA and Apple to adapt his app. As a VA IT official described it in a May 2017 email, “We are utilizing the native iOS mobile app, Emergency Medical Center Tracker, that Dr. Moskowitz developed.”
VA health officials offered their own ideas for how a collaboration with Apple could benefit veterans, such as working on credentialing, data exchange and analytics, and suicide prevention research. But Moskowitz rejected the VA doctors’ ideas in favor of his own. “These are good areas but not the emergency ones which my group of experts have identified,” he said in a May 2017 email. “I sent an email to outline the recommendations.”
Darin Selnick, a VA official who previously signed onto a 2016 proposal to dismantle the agency’s government-run health service, agreed with Moskowitz’s low estimation of the VA doctors’ input. “The VA staff has limited knowledge and experience, which is why you and the” academic medical centers “are so important to help the VA move forward,” Selnick wrote.
Selnick, who is now a special adviser to Wilkie, was the point person working with Moskowitz on the app, the emails show. “I like you are the implementer for VA,” he told Moskowitz in March 2017.
When Selnick said the VA’s information technology division could start working on the app, Moskowitz replied, “We need our specialist.” He then connected Selnick with his son Aaron, and Selnick introducedAaron Moskowitz to Apple. (Aaron Moskowitz’s name is redacted from the emails, but his involvement was confirmed by four people familiar with the matter. He didn’t respond to a request for comment.)
Buzz: As you all may remember Selnick is one of the Koch bros. high profile Concerned Veterans of Am. “graduates.” https://www.militarytimes.com/veterans/2018/05/07/controversial-white-house-advisor-rejoins-va-reform-debate/
VA officials identified major problems with the app’s usability and functionality. “Some of the code needs to be refactored and even rebuilt,” the IT official said in the May email.
Nevertheless, Moskowitz’s son Aaron joined a June 2017 conference call with executives from top medical systems and from Apple, including CEO Tim Cook. Moskowitz wanted the app discussed for five to seven minutes, according to the emails. After the call, Moskowitz named his son as one of the project’s “mid-level project managers.”
In preparation for the conference call, Apple employees and medical experts circulated a memo that assessed Moskowitz’s proposals, which were identified as coming from “the VA and the White House.” In the memo, Apple’s experts pushed back on Moskowitz’s app, saying that the VA’s website already offered a similar tool and that the national databases needed to make the app accurate didn’t exist. Instead, the memo encouraged pursuing a different idea (giving veterans a way to store their health data on their cellphones), which it said would “achieve the greatest benefit for our veterans in the shortest amount of time.”
Apple spokesman Josh Rosenstock didn’t answer requests for comment.
Months later, Moskowitz fumed that the Apple partnership didn’t go his way. “We had an excellent group assembled on the call with Tim Cook,” he said in a March 2018 email. “The VA dropped all contact and proceeded on its own. So now we have a product of limited value.”
A $10 billion technology upgrade championed by Jared Kushner and the Mar-a-Lago trio is at risk of failing the VA’s 7 million patients .
How Marvel Entertainment chairman Ike Perlmutter and two other Mar-a-Lago cronies are secretly shaping the Trump administration’s veterans policies.
Moskowitz also used his influence at the VA to get the agency to convene a meeting on registries for medical devices. Moskowitz started a foundation (whose board included Perlmutter’s wife) that lobbied medical institutions to start such registries so patients could be notified of recalls. Aaron Moskowitz drew a $60,000 salary as the foundation’s director, according to tax filings.
The VA already had a system to notify patients within 10 days of a recall, with a 99 percent success rate, according to internal emails. And the Food and Drug Administration already has a nationwide program to track medical devices. Nevertheless, Moskowitz spurred the VA to organize a conference on the subject, with extensive input from him and his son, according to notes from weekly 7:30 a.m. planning calls. Planning documents named Moskowitz’s foundation as a “participating partner” and a “private interest.”
Moskowitz even had say over the conference’s budget: In an April 2018 email, the VA official running the effort said, “I owe Dr. Moskowitz a budget — Bruce and I are editing it.” Cashour, the VA spokesman, declined to say how much the program cost.
The Mar-a-Lago Crowd’s interventions sometimes bumped into each other. Once, in May 2017, when Selnick tried to schedule a call about the Apple partnership, Moskowitz replied that the time conflicted with another call he had with the acting head of the VA’s health division.
When Wilkie first met the Mar-a-Lago Crowd, they seemed to get along.
“For the first time in 1½ years we feel everyone is on the same page,” Perlmutter said in an email after the meeting at Mar-a-Lago in April. “Everybody ‘gets it.’”
Wilkie returned the enthusiasm, thanking the men for providing a foundation to build on.
“I was honored to visit with you,” Wilkie, who at the time was the acting secretary, wrote. “No matter how long I am here, there is a template in place based on your efforts to move this institution out of the Industrial Age.”
(That last sentence was redacted when the VA originally disclosed the email to ProPublica under the Freedom of Information Act; the agency cited an exemption for internal deliberations. After ProPublica challenged that redaction, the VA released the full message.)
Remember there is a pending law suit against Trump’s appt. of Wilkie as acting Sec. If successful, it could unwind all the decisions Wilkie made as acting VA Sec.
“But Wilkie’s appointment has raised concerns among multiple veterans groups, who have complained the role should have gone to Deputy Secretary Thomas Bowman, the next leader in line at the department. Like Shulkin, Bowman in recent months has sparred with White House officials on policy matters, but White House officials have not yet said whether he will lose his job.
The lawsuit, filed by the left-leaning VoteVets and executive branch watchdog Democracy Forward, charges that by bypassing Bowman, Trump violated the Federal Vacancies Reform Act along with other federal statutes.”)
But since that initial meeting in April, Wilkie’s relationship with the Mar-a-Lago Crowd has frayed. Under pressure from lawmakers after ProPublica’s investigation, Wilkie said in September that his team cut off contact with the trio.
The loss of access has stung Perlmutter, according to a person close to the administration. But Perlmutter remains close to Trump: he spent election night with him and saw him over the Thanksgiving holiday weekend at Mar-a-Lago.
The person, who spoke on the condition of anonymity to describe confidential discussions, said Perlmutter has begun criticizing Wilkie — as he had Wilkie’s predecessor, Shulkin, before the president fired him.
Perlmutter faults Wilkie, the person said, for snubbing Perlmutter’s calls and for sidelining one of his top allies, former acting secretary Peter O’Rourke. Additionally, the person said, Perlmutter is displeased with the agency’s releasing emails about him and with the course of its electronic health records overhaul.
“It’s very clear that Ike is going to war against Wilkie in a similar way to the way he did against Shulkin,” the person familiar with the matter said. “It’s gotten that bad.”
Help us investigate: Do you know what’s going on at the VA? Are you a VA employee or a veteran who receives VA benefits and services? Contact Isaac Arnsdorf at 917-512-0256 or isaac@propublica.org. Here’s how to send tips and documents to ProPublica securely.
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MSM Continues Slow Drip Of Mar-A-Lago Emails: Will Country Club Crony Scandals Dominate VA News Like The Agency’s Own Russia Probe When Democrats Take The House?
More emails on the Mar-a-Lago trio were released yesterday by ProPublica and then dripped throughout MSM yesterday in much the same way as continued news about the Mueller probe.
ProPublica is now calling the trio “VA Shadow Rulers” with their fingers in practically every deep pie involving dollar signs. Sounds ominous.
The new emails reveal deeper involvement in government contracting and personnel decisionmaking than previously known. Greater details are also now known concerning Apple app creation and ingratiation with VA.
Marvel Entertainment chairman Ike Perlmutter, West Palm Beach physician Bruce Moskowitz and lawyer Marc Sherman — part of the president’s circle at his Mar-a-Lago resort in Florida.
Secretary of Veterans Affairs Robert Wilkie has attempted to distance himself from the trio’s involvement after negative press started in August. Press secretary Curt Cashour is now blaming previous leaders for failing to stand tall against President Donald Trump’s cronies.
“Although his predecessors may have done things differently, Sec. Wilkie has been clear about how he does business,” Cashour said in a statement. “No one from outside the administration dictates VA policies or decisions — that’s up to Sec. Wilkie and President Trump. Period.”
Wilkie now says the agency has cut off communications with the trio.
According to the story:
But since that initial meeting in April, Wilkie’s relationship with the Mar-a-Lago Crowd has frayed. Under pressure from lawmakers after ProPublica’s investigation, Wilkie said in September that his team cut off contact with the trio.
The loss of access has stung Perlmutter, according to a person close to the administration. But Perlmutter remains close to Trump: he spent election night with him and saw him over the Thanksgiving holiday weekend at Mar-a-Lago.
The person, who spoke on the condition of anonymity to describe confidential discussions, said Perlmutter has begun criticizing Wilkie — as he had Wilkie’s predecessor, Shulkin, before the president fired him.
Perlmutter faults Wilkie, the person said, for snubbing Perlmutter’s calls and for sidelining one of his top allies, former acting secretary Peter O’Rourke. Additionally, the person said, Perlmutter is displeased with the agency’s releasing emails about him and with the course of its electronic health records overhaul.
“It’s very clear that Ike is going to war against Wilkie in a similar way to the way he did against Shulkin,” the person familiar with the matter said. “It’s gotten that bad.”
If Trump fails to get ahead of this story, it will likely take all the focus off real problems within the agency like no accountability for senior officials and veterans dying. Which, in a sense, is a win-win for both parties.
You can count on this story dripping out into a full-blown scandal once Democrats retake the House in January at a time when more emphasis must be on the GI Bill and continued failures to help veterans relying on the Caregiver Program of seeking Disability Compensation.
There are too many problems to focus on this kind of garbage, but it does need to at least be addressed if the nature of the involvement was unlawful or unethical in some manner. Let’s just hope the Mar-a-Lago trio does not become the VA’s version of the Mueller probe.
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https://www.stripes.com/news/gao-agrees-to-investigate-mar-a-lago-members-influence-on-va-1.558148
GAO agrees to investigate Mar-a-Lago members' influence on VA
WASHINGTON — A top government watchdog has agreed to investigate the amount of influence three wealthy members of President Donald Trump’s private club in Palm Beach, Fla., exerted over the Department of Veterans Affairs.
In a letter released Monday, the Government Accountability Office accepted a request from Sens. Elizabeth Warren, D-Mass., and Brian Schatz, D-Hawaii, to investigate the trio’s influence over national veterans policies. Orice Williams Brown, managing director of congressional relations for the GAO, wrote in the letter that it was “within the scope of its authority.”
But the GAO won’t have the staff available to investigate for another five months, Brown wrote.
ProPublica first reported in August that Marvel Entertainment Chairman Ike Perlmutter, lawyer Marc Sherman and Bruce Moskowitz, a Palm Beach doctor, used their proximity to the president to influence VA operations. Though none of them have served in the U.S. military or government, they steered VA officials on policies affecting millions of Americans, ProPublica reported.
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Since the report, numerous lawmakers have requested information from the VA, as well as investigations from the GAO and VA Office of Inspector General.
The VA Office of Inspector General declined to investigate until a private lawsuit on the issue is settled.
VoteVets, a liberal advocacy group, filed a lawsuit in August against VA Secretary Robert Wilkie. VoteVets argues in the suit that the existence of the secret council broke the Federal Advisory Committee Act, an open government law that requires transparency of outside advisory groups.
Citing the ongoing litigation, Wilkie has refused to hand over information to lawmakers that could help reveal the extent of the Mar-a-Lago trio’s influence. Rep. Tim Walz, D-Minn., the ranking Democrat on the House Committee on Veterans’ Affairs, had requested copies of any correspondence between the three men and current and former VA employees.
When Wilkie said he would not provide the information, Walz accused the VA of trying to “sweep this under the rug.”
The GAO accepted the request by Warren and Schatz to investigate, but the scope of that investigation is unclear so far. Warren and Schatz asked the watchdog group to look into the trio’s access to the secretary and other top VA officials, the decision-making role the men took at the VA and whether they or their families benefitted financially from their access.
“Membership in President Trump’s private club, alone, is not sufficient to have an informed opinion on the best way to deliver care and benefits to our nation’s veterans,” Warren and Schatz wrote in their letter to the GAO. “And membership in President Trump’s private club should not give any individual the right to exert influence on decisions made by the VA that impact the over nine million veterans under its care.”
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FROM THE HILL November 13, 2018 - 06:00 AM EST
VA under pressure to deliver Trump reforms
GETTY IMAGES
A law overhauling how the Department of Veterans Affairs (VA) allows patients to seek outside care is falling behind in implementation despite President Trump's boasts about the reforms.
Trump has long touted the law, which makes it easier for veterans to access private or community health-care programs, as essential to improving the beleaguered agency.
The law, signed in June, allows for a yearlong implementation period, and veterans say they would rather it be done right than hastily.
"It has not got to a point of panic just yet," said Carlos Fuentes, legislative director at the Veterans of Foreign Wars. "We certainly want to make sure that it's implemented correctly instead of rushed to implementation. That's one of the issues with the Choice program."
But veterans groups are also watching the process intently, and the VA is under pressure to implement the new law in time.
The law in question, the VA Mission Act, is the replacement to the VA Choice Act, a program first established in 2014 during the Obama administration. The Choice program was created after the VA wait-time scandal where administrators were found to be doctoring appointment schedules to cover up problems providing veterans health care.
The Choice program gives veterans facing long wait times at the VA or who would have to travel far to reach a VA facility the ability to seek private health care paid for by the government. About 30,000 appointments per day are funded through the Choice program.
(Buzz: At the end of Fed. Fiscal Yr. 2017 40% of all VA completed outpatient appointments were conducted in the private sector and 60% at the VA. At the end of FFY 2018 which was 9-30-18 I do not yet have those stats but my guess is 45% or more of such appts. are now being made in the private sector. Point: it is likely that nearly half the VA outpatient appt. work is now taking place in the private sector. I would say the VA is already privatized.)
But the program, which had a 90-day implementation period, has faced numerous issues, from complaints that it wasn't being used enough to, more recently, repeatedly running out of money.
The $55 billion Mission Act seeks to address the issues with Choice by overhauling and consolidating the network of private health-care providers where veterans can use their benefits. The law passed with large bipartisan majorities in both chambers of Congress.
"Congress has done what no Congress has ever done. They have given us the roadmap for success," Veterans Affairs Secretary Robert Wilkie said Friday at a "State of the VA" address, referring to the Mission Act and other bills. "Today, we are working to give veterans more choice in their health-care decisions because of the Mission Act."
The Mission Act has become a much-touted accomplishment for Trump, who during his 2016 campaign released a 10-point plan to "make the VA great again."
Among the 10 points was a promise to expand veterans' choices to use private health care.
"I've done more for the vets than any president has done, certainly in many, many decades, with Choice and with other things, as you know," Trump said unprovoked at a press conference last week. Trump often refers to the Mission Act as "Choice."
The implementation involves some difficult choices for VA officials.
Among the questions officials need to answer before June 2019 are who will be eligible for private care, how much involvement VA doctors will have in that decision and how the pay structures will work.
An FAQ posted to the VA website said implementation of the changes will take some time and urged patience.
"Due to the significant complexity associated with health care delivery, the large size of the VA health care system, along with VA's network of more than half a million community providers, adequate time and consideration is required to properly develop the required regulations and necessary system changes and training for successfully implementing the consolidated community care program," the VA wrote.
"A lesson learned from the implementation of the Veterans Choice Program is that rushing implementation wasted resources and did not serve Veterans, providers, or VA well."
Already some issues have cropped up. The VA has yet to award up to four contracts to companies to develop and
administer regional networks of private health-care providers. That delay has already attracted the attention of lawmakers.
"I am troubled that the awarding of these contracts has been repeatedly delayed, given these [networks] will facilitate veterans receiving care in the community by establishing networks of providers ready and willing to see veterans," Sen. Jon Tester (D-Mont.), ranking member of the Veterans Affairs Committee, wrote in an August letter to Wilkie.
Last month, the VA announced it reached an agreement with TriWest Health Care Alliance for a one-year extension of its current contract to "ensure access to community care" until the contracts are awarded and implemented.
(Buzz: TriWest’s CEO is Sen. McCain’s former chief of staff who just happened to end up the TriWest CEO and TriWest just happened to end up as one of two companies to handle the Choice progam in 2014 after Choice was decided upon at a meeting between Sanders and McCain. McCain got Choice. Sanders got $5 billion to hire more VA staff if my memory is correct. It is one of the worst deals, I believe, that Sanders every made. TriWest is found to have been defrauding the feds of millions of dollars and was under investigation by a fed. grand jury. I do not know what happened to that case. But as many times happens in white collar crime some money is paid back and highly connected companies still end up on the government corporate welfare dole.https://www.militarytimes.com/news/2018/10/02/triwest-takes-over-va-community-care-programs-nationwide/ )
The VA plans to award the contracts for regions one through three by the end of 2018 and for region four by January 2019, according to Tester's letter.
The networks for regions one through three aren't expected to be fully operational until December 2019, Tester said, and "even later" for region four.
"I am extremely frustrated that veterans may not receive the benefit of a fully-operational network to go along with their revamped eligibility for community care on day one," Tester wrote in the letter.
Adding to the concerns about the Mission Act, many veterans are already on edge because the implementation of another planned overhaul has already brought new problems.
The Forever GI Bill, passed in summer 2017, was supposed to expand education benefits for veterans, but veterans have not been getting their benefits because the new processing systems are not working properly.
For the Mission Act, veterans groups say they are watching closely to make sure both that the implementation isn't delayed and that the mistakes of the Choice program aren't repeated.
"We don't want the VA to be hasty to the point of making mistakes that could negatively impact veterans, but we always don't want them to be slow or drag their feet," said John Hoellwarth, a spokesman for AMVETS.
AMVETS is particularly watching to see how the VA keeps private health-care providers accountable, he added.
"The VA answers to Congress; who do community care providers answer to?" Hoellwarth asked.
Fuentes, at the Veterans of Foreign Wars, said the VA has been doing a good job of keeping veterans informed on the progress of implementing the law and that communication has improved since Wilkie was confirmed in July.
Still, he added, the department could do better in soliciting input from veterans rather than just updating them on its work.
Veterans groups are also wary that the Mission Act is a stepping stone to replacing the VA health-care system with private care altogether. While the VA has its issues, they argue, it's also uniquely qualified to treat veterans and should be fixed rather than undermined with the expansion of private care.
