Corrupt Scheme to Monetize Veteran Health Records Uncovered

https://d-s-nelson.medium.com/corrupt-scheme-to-monetize-veteran-health-records-uncovered-a3a60c4ec269

A press release posted by the House Committee on Oversight and Reform today provides the results of an investigation by the committee uncovering a corrupt scheme by several Trump Administration associates to capitalize on suffering veterans.

The three accused Trump associates from the former president’s private golf club known as the “Mar-a-Lago Trio” as reported by CNBC News “are billionaire Marvel Entertainment Chairman Ike Perlmutter, attorney Marc Sherman and doctor Bruce Moskowitz.” It is reported that both Jared Kushner and Ivanka Trump were aware of the efforts by the trio to profit from their shaping of Veterans Administration (VA) policies. The “Mar-a-Lago Trio” reportedly meant to monetize VA health records in a “hugely profitable” deal with Johnson & Johnson, Apple, and CVS and flouted Federal Advisory Committee Act (FACA) requirements.

The House Committee on Oversight and Reform states:

“‘Our joint investigation found that Ike Perlmutter, Marc Sherman, and Dr. Bruce Moskowitz, bolstered by their connection to President Trump’s private Mar-a-Lago club, violated the law and sought to exert improper influence over government officials to further their own personal interests,’ said the Chairs.”

Background: FACA Flouted by Associates

FACA lays out the rules of engagement for advisory committees. However, when Reed Cordish, a former senior aide to President Donald Trump advised the trio of the need to “form a FACA group,” billionaire Marvel Entertainment Chairman Ike Perlmutter responded:

“Thanks for your email and especially the thoughts on FACA. The good news is that we have been advised that FACA does not apply because we are not a formal group in any way.”

The Oversight Committee released the trove of emails today.

Former President Trump announced the administration’s intention to set up a group to “straighten out the VA” on January 11, 2017. The oversight committee report goes on to say that the trio would “help then-VA Secretary nominee David Shulkin implement new policies, including a proposal to monetize veterans’ patient data.”

According to the oversight committee:

“The Federal Advisory Committee Act (FACA) requires that groups advising the executive branch operate with transparency and a balanced approach. The Mar-a-Lago Trio refused to comply with this law and, with the knowledge of Jared Kushner, Ivanka Trump (using a personal email account), and other top White House advisors, hid their efforts to influence VA policies from public view.”

The Oversight Committee goes on to say that:

“The Trio was informed by multiple federal officials that their work constituted an advisory committee, which is subject to the transparency and balance requirements in FACA.”

Veterans and the Overdose Crisis: White House Appears to Have Been Aware of Issue of Veteran Suicides

It is well known within communities that the VA health system was the first to begin targeting patients with anti-medication management policies concerning the treatment of pain. Many advocates have tweeted to the Trump White House and written letters, and even held protest rallies against the policies which began proliferating within the rest of the healthcare system via state and federal initiatives to mitigate the so-called “opioid crisis.” Especially in the wake of the Centers for Disease Control and Prevention’s (CDC) 2016 Guidelines on Prescribing Opioids for Chronic Pain.

The email trove released by the Oversight Committee appears to show the Trump White House knew veteran suicides were an issue and it’s possible they also knew that many of the suicides may be linked to heavy-handed policies at the VA due to incorrect assumptions about what was driving the overdose crisis.

One of the emails from Ike Perlmutter to Reed Cordish states:

“Our team of medical experts are working on a telehealth initiative and delivered a draft Executive Order to the President…while you are working with the DEA and DOJ, without the courtesy of advising us, which could have tremendous implications on the wording or, worse yet, the prudence of an Executive Order in the first place. This parallel path as well creates the potential for embarrassment for the President and wasted invaluable time that our veterans can ill afford. … We will arrange and conduct discussions with Apple…”

The emails clearly depict the trio and White House officials held discussions with Johnson & Johnson, Apple, and CVS Health on behalf of the federal government after Ivanka Trump and Jared Kushner introduced them to the CEOs of each company — Alex Gorsky, Tim Cook, and Larry Merlo. It’s also clear they were coordinating with the DEA and DOJ.

The Oversight Committee report says:

“The trio engaged these companies on proposals including the development of a platform for veterans’ medical records, efforts to reduce veteran suicides including a joint public awareness campaign, and efforts to expand access to care for veterans by providing veterans service at CVS’ MinuteClinics.”

The report goes on to say:

“The Trio worked with Secretary Shulkin to award a consulting contract to Terry Fadem, the former president of Dr. Moskowitz’s nonprofit foundation, to explore monetizing VA patient data. Mr. Fadem proposed in an email exchange with Dr. Moskowitz that patient data ‘be leveraged into hundreds of millions in revenue.’ Dr. Moskowitz responded that ‘J&J, CVS, and Apple all wanted the data base’ and that Johnson & Johnson ‘want[s] the VA databank and biobank which will be hugely profitable to them.’ [p. 24–27] According to a presentation prepared by Johnson & Johnson, a next step was to ‘Work through legal barriers on getting access to VHA EMR [Veterans Health Administration Electronic Medical Records] databases.’ [p.33]”

There was no acknowledgment of the heavy-handed federal response to the overdose crisis which began targeting patients and their doctors several years ago. Federal and state policies have made them targets of the United State’s war on drugs despite most overdoses being the result of illicitly manufactured fentanyl (IMF) in the black market supply.

Data from both the VA and the American Medical Association (AMA) demonstrate that veterans and many more in the private sector were rapidly force tapered off of their medications. According to Dr. Michael Schatman, the Editor-in-Chief of the Journal of Pain Research, the VA force tapered veteran patients twice as quickly as the private sector.

From a 2018 VA report:

“Highlights from the data include:

• A 41-percent drop in opioid-prescribing rates across VA between 2012 and 2017
• Ninety-nine percent of facilities decreased their prescribing rates.
• San Juan, Puerto Rico, and Cleveland, Ohio, top the list of medical centers with the lowest prescribing rates, at 3%.
• El Paso, Texas, and Fayetteville, North Carolina, are most improved, and decreased prescribing rates by more than 60 percent since 2012. El Paso’s prescribing rate decreased by 66%, and Fayetteville’s decreased by 65%”[1]

The AMA’s 2018 data is similar but includes decreases in prescribing across sectors:

“Opioid prescriptions are decreasing nationwide.

Between 2013 and 2017, the number of opioid prescriptions decreased by more than 55 million — a 22.2 percent decrease nationally. All 50 states have seen a decrease in opioid prescriptions over the last five years.

The nation saw a 9 percent decrease — more than 19 million fewer prescriptions — between 2016 and 2017 alone.”[2]

And in 2021, the AMA demonstrates that our current policies concerning prescription medications for pain are inadequate because the problem never stemmed from prescribing but rather the black market drug supply being poisoned by IMF.

It’s a shame the trio and the administration didn’t “work through legal barriers” of veterans and other patients getting access to life-saving medications considering it’s obvious they are capable of working through such barriers when it suited their wallets.

The Poisoning Crisis Continues Unabated

Despite this drastic decrease in prescribing, the United States experienced its worst year of overdoses yet in 2020, and statistics for 2021 are likely to be just as dismal.

The reason? Federal and state public health agencies and legislatures are focusing on the wrong premise. The assumption made by the CDC and other federal agencies is that it is patients on medications for pain and their prescribing doctors that are driving the overdose crisis. However, as this author has previously uncovered, CDC’s data on unintentional overdoses is fatally flawed and combines heroin and illicit fentanyl poisonings within their “prescription opioid overdose” categories.

Overdoses are not the result of prescriptions being given to patients but rather, are a result of IMF proliferating on the streets. Poisoning the illicit drug supply, along with the problem of polypharmacy (users taking several drugs at once).

In fact, a recent study utilizing the Prescription Drug Monitoring Program (PDMP) may be widely representative. The study was undertaken by Alexander Walley, a researcher at Boston Medical Center and Associate Professor of Medicine at Boston University School of Medicine. It was discovered that only about 1% of overdose decedents had an active prescription at the time of death and that a majority had died of heroin or fentanyl overdose.

Even in cases of decedents overdosing on so-called “prescription opioids,” they are almost never prescribed to them. And yet, patients continue to bear the weight of the drug war and are expected to face continued barriers in accessing medication management for their pain, while poisoning of the black market supply continues unabated.

It is reported that almost 20 veterans commit suicide every day. Many of these suicides are likely a direct result of their inability to access medications that allow them to remain active and the cruel theft of their quality of life is likely similarly correlated with this frightening trend. Instead of attempting to restore access to these life-saving medications, or at the very least, work on decreasing barriers to appropriate treatment, the trio and the Trump White House appear to have been planning a way to profit from these veterans’ suffering. Going so far as to plan a joint public awareness campaign leveraging celebrities from Marvel Entertainment.

No doubt these veterans, suffering from the obligatory yet failing drug war, are beyond grateful to hear that their medical records were to be leveraged into “hundreds of millions in revenue” and that the trio and the administration were planning to profit while throwing them some “awareness” via a celebrity circus. It’s too bad they didn’t take it a step further and redirect federal resources to target the real problem, IMF in a completely separate black market supply, and relax the prohibition of pain medications on the medical side via VA policies.

Conclusion: Calls for Greater Transparency

At the very least, we can expect discussions on efforts to increase transparency when it comes to advisory committees. The Oversight Committee writes:

“…The Committees’ investigation demonstrates the need for Congress to pass the Federal Advisory Committee Transparency Act, which would ensure the American people know who is providing advice to federal policymakers and would require agencies to disclose whether individuals on advisory committees have conflicts of interest.”

As most of my readers already know, the problem of material conflicts of interest and a culture of federal public health agencies ignoring ethics frameworks and their own rules is nothing new. However, more transparency for advisory committees in the wake of these revelations is sure to be a positive development.

Filed under: General Problems