Last February, shortly after Peter O’Rourke became chief of staff for the Department of Veterans Affairs, he received an email from Bruce Moskowitz with his input on a new mental health initiative for the VA. “Received,” O’Rourke replied. “I will begin a project plan and develop a timeline for action.”
O’Rourke treated the email as an order, but Moskowitz is not his boss. In fact, he is not even a government official. Moskowitz is a Palm Beach doctor who helps wealthy people obtain high-service “concierge” medical care.
More to the point, he is one-third of an informal council that is exerting sweeping influence on the VA from Mar-a-Lago, President Donald Trump’s private club in Palm Beach, Florida. The troika is led by Ike Perlmutter, the reclusive chairman of Marvel Entertainment, who is a longtime acquaintance of President Trump’s. The third member is a lawyer named Marc Sherman. None of them has ever served in the U.S. military or government.
Yet from a thousand miles away, they have leaned on VA officials and steered policies affecting millions of Americans. They have remained hidden except to a few VA insiders, who have come to call them “the Mar-a-Lago Crowd.”
Perlmutter, Moskowitz and Sherman declined to be interviewed and fielded questions through a crisis-communications consultant. In a statement, they downplayed their influence, insisting that nobody is obligated to act on their counsel. “At all times, we offered our help and advice on a voluntary basis, seeking nothing at all in return,” they said. “While we were always willing to share our thoughts, we did not make or implement any type of policy, possess any authority over agency decisions, or direct government officials to take any actions… To the extent anyone thought our role was anything other than that, we don’t believe it was the result of anything we said or did.”
VA spokesman Curt Cashour did not answer specific questions but said a “broad range of input from individuals both inside and outside VA has helped us immensely over the last year and a half.” White House spokeswoman Lindsay Walters also did not answer specific questions and said Perlmutter, Sherman and Moskowitz “have no direct influence over the Department of Veterans Affairs.”
But hundreds of documents obtained through the Freedom of Information Act and interviews with former administration officials tell a different story — of a previously unknown triumvirate that hovered over public servants without any transparency, accountability or oversight. The Mar-a-Lago Crowd spoke with VA officials daily, the documents show, reviewing all manner of policy and personnel decisions. They prodded the VA to start new programs, and officials travelled to Mar-a-Lago at taxpayer expense to hear their views. “Everyone has to go down and kiss the ring,” a former administration official said.
If the bureaucracy resists the trio’s wishes, Perlmutter has a powerful ally: The President of the United States. Trump and Perlmutter regularly talk on the phone and dine together when the president visits Mar-a-Lago. “On any veterans issue, the first person the president calls is Ike,” another former official said. Former administration officials say that VA leaders who were at odds with the Mar-A-Lago Crowd were pushed out or passed over. Included, those officials say, were the secretary (whose ethical lapses also played a role), deputy secretary, chief of staff, acting under secretary for health, deputy under secretary for health, chief information officer, and the director of electronic health records modernization.
At times, Perlmutter, Moskowitz and Sherman have created headaches for VA officials because of their failure to follow government rules and processes. In other cases, they used their influence in ways that could benefit their private interests. They say they never sought or received any financial gain for their advice to the VA.
No financial gain. Well…. How about nepotism and favors for friends?
Perlmutter, Moskowitz and Sherman acted like board members pounding a CEO to turn around a struggling company, a former administration official said. In email after email, officials sought approval from the trio: for an agenda Shulkin was about to present to Trump for a research effort on suicide prevention and for a plan to recruit experts from academic medical centers. “Everything needs to be run by them,” the first former official said, recalling the process. “They view themselves as making the decisions.”
The Mar-a-Lago Crowd bombarded VA officials with demands, many of them inapt or unhelpful. On phone calls with VA officials, Perlmutter would bark at them to move faster, having no patience for bureaucratic explanations about why something has to be done a certain way or take a certain amount of time, former officials said. He issued orders in a thick, Israeli-accented English that can be hard to understand.
In one instance, Perlmutter alerted Shulkin to what he called “another real-life example of the issues our great veterans are suffering with when trying to work with the VA.” The example came from Karen Donnelly, a real estate agent in Palm Beach who manages the tennis courts in the luxury community where Perlmutter lives. Donnelly’s son was having trouble accessing his military medical records. After a month of dead ends, Donnelly said she saw Perlmutter on the tennis court and, knowing his connection to Trump, asked him for help. Perlmutter told her to email him the story because he’s “trying to straighten things out” at the VA, she recalled. (Donnelly separately touched off a nasty legal dispute between Perlmutter and a neighbor, Canadian businessman Harold Peerenboom, who objected to her management of the tennis courts. In a lawsuit, Peerenboom accused Perlmutter of mounting a vicious hate mail campaign against him, which Perlmutter’s lawyer denied.)
Perlmutter forwarded Donnelly’s email to Shulkin, Moskowitz and Sherman. “I know we are making very good progress, but this is an excellent reminder that we are also still very far away from achieving our goals,” Perlmutter wrote.
Shulkin had to explain that they were looking in the wrong place: Since the problem was with military service records, it lay with the Defense Department, not the VA.
Perlmutter, Moskowitz and Sherman defended their intervention, saying, “These were the types of stories of agency dysfunction and individual suffering that drove us to offer our volunteer experience in the first place — veterans who had been left behind by their government. These individual cases helped raise broader issues for government officials in a position to make changes, sometimes leading to assistance for one veteran, sometimes to broader reforms within the system.”
Right after meeting Shulkin, Moskowitz connected him with his friend Michael Zinner, director of the Miami Cancer Institute and a member of the American College of Surgeons’ board of regents. (Zinner declined to comment.) The conversation led to a plan for the American College of Surgeons to evaluate the surgery programs at several VA hospitals. The plan came very close to a formal announcement and contract, internal emails show, but stalled after Shulkin was fired, according to the organization’s director, David Hoyt.
Hmmmm. What about self-dealing?
Besides advocating for friends’ interests, some of the Mar-a-Lago Crowd’s interventions served their own purposes. Starting in February 2017, Perlmutter convened a series of conference calls with executives at Johnson & Johnson, leading to the development of a public awareness campaign about veteran suicide. They planned to promote the campaign by ringing the closing bell at the New York Stock Exchange around the time of Veterans Day.
The event also turned into a promotional opportunity for Perlmutter’s company. Executives from Marvel and its parent company, Disney, joined Johnson & Johnson as sponsors of the Veterans Day event at the stock exchange. Shulkin rang the closing bell standing near a preening and flexing Captain America, with Spider-Man waving from the trading pit, and Marvel swag distributed to some of the attendees. “Generally the VA secretary or defense secretary don’t shill for companies,” the leader of a veterans advocacy group said.
The VA was aware of the ethical questions this event raised because of Shulkin’s relationship with Perlmutter. An aide to Shulkin sought ethics advice from the agency’s lawyers about the appearance. In an email, the aide noted, “the Secretary is friends with the President of Marvel Comics, Mr. Ike Perlmutter, but he will not be in attendance.” The VA redacted the lawyer’s answer, and the agency’s spokesman would not say whether the ethics official approved Shulkin’s participation in the event.
Perlmutter did not answer specific questions about this episode. His joint statement with Moskowitz and Sherman said, “None of us has gained any financial benefit from this volunteer effort, nor was that ever a consideration for us.”
Well, that’s debate-able. And what’s this — ACTUAL nepotism:
Perlmutter also facilitated a series of conference calls with senior executives from Apple. VA officials were excited about working with the company, but it wasn’t immediately obvious what they had to collaborate on.
As it turned out, Moskowitz wanted Apple and the VA to develop an app for veterans to find nearby medical services. Who did he bring in to advise them on the project? His son, Aaron, who had built a similar app. The proposal made Apple and VA officials uncomfortable, according to two people familiar with the matter, but Moskowitz’s clout kept it alive for months. The VA finally killed the project because Moskowitz was the only one who supported it.
Moskowitz, in the joint statement, defended his son’s involvement, calling him a “technical expert” who participated in a single phone call alongside others. “Any development efforts, had they occurred, would not have involved Aaron or any of us. There was no product of Dr. Moskowitz’s or Aaron’s that was promoted or recommended in any way during the call,” the trio said. “Again, none of us, including Aaron, stood to receive any financial benefit from the matters discussed during the conversation — and any claims to the contrary are factually incorrect.”
Moskowitz had more success pushing a different pet cause. He has spent years trying to start a national registry for medical devices, allowing patients to be notified of product recalls. Moskowitz set up the Biomedical Research and Education Foundation to encourage medical institutions to keep track of devices for their patients to address what he views as a dangerous hole in oversight across the medical profession. At one point, the foundation built a registry to collect data from doctors and patients. Moskowitz chaired the board, and Perlmutter’s wife was also a member. Moskowitz’s son earned $60,000 a year as the executive director, according to tax disclosures.
Moskowitz pushed the VA to pick up where he left off. He joined officials on weekly 7:30 a.m. conference calls in which officals discussed organizing a summit of experts on device registries and making a public commitment to creating one at the VA. In an email to Shulkin, the VA official in charge of the project referred to it as the “Bruce Moskowitz efforts.”
When the summit arrived, on June 4, Moskowitz and his son did not attend. It’s not clear what role they will have in setting up the VA’s registry going forward — their foundation has shut down, according to its website, and Moskowitz’s son said he’s no longer involved. But in his opening remarks at the summit, Peter O’Rourke, then the acting secretary, offered a special thanks to “Dr. Bruce Moskowitz and Aaron Moskowitz of the Biomedical Research and Education Foundation” as “driving forces” behind it.
So basically, you have three guys trying to fix the VA, with no accountability at all.
Read the whole thing…. and welcome to the swamp.