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本文由《財富》雜志與非營利調查新聞機構ProPublica合作完成。

在去年一場創(chuàng)傷后應激障礙的眾議院聽證會上,，一家私人機構提出了雄心勃勃的計劃幫助受疾病困擾的退伍軍人,。科恩退伍軍人網(wǎng)絡打算在美國多地開設免費的心理健康診所,，主要靠對沖基金億萬富翁史蒂夫·科恩捐出的2.75億美元資金支持,。

與經(jīng)常曝出丑聞的美國退伍軍人事務部相比，科恩網(wǎng)絡稱客戶滿意度達96%,。在一份聽證會聲明中,，該組織表示網(wǎng)絡各診所“為解決退伍軍人問題提供了理想的選擇” ，這也是明確回應特朗普大選時的承諾,，即讓退伍軍人跳過退伍軍人事務部,，轉而選擇“私人服務提供商”,。

言猶在耳，科恩網(wǎng)絡在洛杉磯的診所卻開業(yè)不到一年就關閉了,。前雇員說，公司管理層曾讓員工優(yōu)先考慮更健康的病人而不是無家可歸的退伍軍人,，雙方早已出現(xiàn)隔閡,。但關閉的決定非常突然，前治療師表示,，一些病人非常失望,。

在特朗普政府執(zhí)政期間，私有化成為退伍軍人事務部的爭議焦點,?？剖闲值芎涂稀だ矢衲岬缺Ｊ嘏蓛|萬富翁希望退伍軍人盡可能去看私人醫(yī)生，而傳統(tǒng)的退伍軍人組織希望政府繼續(xù)負責醫(yī)療系統(tǒng),。

科恩網(wǎng)絡已成為雙方的測試案例,。要么證明私營部門能比退伍軍人事務部更高效完成工作，要么變成納稅人資金轉移到不靠譜私人機構的范例,。

史蒂文·科恩可能還沒注意自己身處交火中心,。他最出名的身份是億萬富翁對沖基金巨頭，股票回報令全華爾街羨慕,，后來聯(lián)邦檢察官以內幕交易為由突擊搜查了他的公司,。（62歲的科恩未受到指控；他拒絕接受本文作者采訪,。）之后,，科恩成立了一只新對沖基金Point72，還在全國開設了10家診所為退伍軍人服務,。

徹底檢查科恩網(wǎng)絡各項記錄后,，包括內部文件、電子郵件和對現(xiàn)任和前任員工的數(shù)十次采訪,，呈現(xiàn)出與該公司講述完全不同的故事,。前雇員表示，南加州大學診所之所以最終關閉,，主要因為科恩網(wǎng)絡管理不善,，而且對象比較窄，只能照顧一小部分退伍軍人,?！拔覀冏罱K找到真正能幫到退伍軍人的模式與科恩網(wǎng)絡診所的模式并不一樣?！瘪R弗·薩瑟德表示,，他曾擔任南加州大學科恩診所首席執(zhí)行官,，現(xiàn)任南加州大學醫(yī)生社會工作項目的主席。

科恩網(wǎng)絡最早在紐約大學成立的診所也遇到了麻煩,，原因是對科恩資助的研究專利權產(chǎn)生糾紛,。聽證會結束后不久，科恩積極開展游說,，希望政府出手補貼診所,。

科恩網(wǎng)絡和科恩的發(fā)言人堅稱從未想把退伍軍人事務部私有化，唯一的目標就是幫助退伍軍人,?？贫鞯陌l(fā)言人馬克·赫爾表示：“在美國，再沒人比科恩更積極出錢拯救退伍軍人的生命,，滿足退伍軍人的精神需求,。”科恩網(wǎng)絡認為在洛杉磯,、紐約和華盛頓出現(xiàn)的問題都是別人的原因,。

從科恩網(wǎng)絡的故事可以看出，特朗普為實現(xiàn)競選承諾讓私營部門負責退伍軍人,，究竟意味著什么,。

2016年年中，科恩網(wǎng)絡在洛杉磯開設診所,，吸引了不少優(yōu)秀的治療師,，因為錢似乎不是問題，是難得的給退伍軍人治病機會,?！昂喼碧昝溃疾幌裾娴??！币晃慌R床醫(yī)生說。 “回過頭看確實不是真的,?！?

工作人員剛就位就開始感到失望。原來該診所在南加州大學里,，只有條走廊,，還跟皮膚科共享。六位治療師只有三間治療室,，只能輪流問診,，到另一處辦公室還得步行幾個街區(qū)。

另一個問題是儲存患者病歷的軟件。市面上很多系統(tǒng)都不好用,，但臨床醫(yī)生都表示該系統(tǒng)堪稱最差,。他們經(jīng)常寫長文提交后發(fā)現(xiàn)會話超時，不得不重新開始,。會話填寫的筆記也會神秘地消失,。“完全達不到之前的預期,?！痹\所主任凱瑟琳·阿內特表示。

據(jù)前雇員透露,，科恩網(wǎng)絡首席執(zhí)行官安東尼·哈桑堅決否認軟件收到投訴，所以工作人員只能私下開電話會議排除故障,。哈桑書面回答問題時表示,，指責他罵員工討論軟件“荒謬虛假”。他還否認軟件出過問題,，他說“系統(tǒng)里沒有漏洞,。”

但2017年2月內部審查結論是：“系統(tǒng)里持續(xù)存在臨床數(shù)據(jù)錯誤,?！笨贫骶W(wǎng)絡的高層寫道。

由于問題層出不窮,，一些現(xiàn)任和前任員工懷疑科恩網(wǎng)絡公布的結果,。舉例來說，該網(wǎng)絡首席運營官于2016年10月在一封電子郵件中稱,，客戶滿意度調查僅由6%的現(xiàn)有患者完成,。科恩網(wǎng)絡稱,，回應率已上升至59%,。盡管如此，該比例仍低于已發(fā)表研究的普遍比例,，也說明最終打分可能并不代表所有患者的觀點,，而且有證據(jù)表明心情愉快的患者完成調查的幾率更高。（“我們對數(shù)據(jù)的完整性充滿信心,?！惫Ｕf，但他拒絕解釋如何檢查和驗證數(shù)據(jù),。）

科恩網(wǎng)絡需要更多的患者,，對投票率低也很不滿：一項內部審查發(fā)現(xiàn)，前六個月洛杉磯診所僅有116名客戶,，每個客戶的成本為10,282美元,?！捌骄杀舅椒浅Ａ钊藫模蛻魯?shù)量少也讓人不安,?！眱晌桓吖軐懙馈Ｒ恍┡R床醫(yī)生發(fā)現(xiàn)公共機構或現(xiàn)金拮據(jù)的非營利組織比較注重成本和數(shù)量,，但資金充足的科恩網(wǎng)絡如此吝嗇令人不解,。

科恩網(wǎng)絡過于注重可測量的結果，影響了診所提供的治療服務,。臨床醫(yī)生應該采用一套有助于創(chuàng)傷后應激障礙,、失眠、抑郁和焦慮的治療方案,，為期6到15周,。

但患者通常有多種情況，并不一定適合12周療程,。由于科恩網(wǎng)絡治療范圍有限,，其他一些服務退伍軍人服務不再推薦?！八麄兊哪Ｊ皆趨⑴c和后續(xù)護理方面投入不夠,，而且過于注重短期干預?！彼_瑟德表示,，擔任科恩診所首席執(zhí)行官之前他曾負責洛杉磯縣精神衛(wèi)生部門17年。 “南加州大學與科恩網(wǎng)絡愿景之間最大的分歧,，”他說,，“在于我們的目標是問題很嚴重且困難很大的病人，而且要找到能提供幫助的模式,?！?

由于科恩網(wǎng)絡更關注創(chuàng)傷后應激障礙的可測量結果，洛杉磯診所回絕了一些需求急迫的患者,。由于診所位于洛杉磯市中心貧民區(qū),，許多就診的退伍軍人無家可歸。無家可歸者很難跟進治療,，可能會拖累診所的指標,。在一份內部備忘錄中，科恩網(wǎng)絡的負責人就曾批評員工“接待不合適的客戶群（例如,，暫住者/無家可歸者,，長期精神病患者）。”

診所的工作人員很受打擊,?！拔覀儊淼竭@里都以為可以幫助最需要的人，負責人卻說不能幫,?！蹦霞又荽髮W診所的主任阿內特說?！八麄冓s走了情況最差的退伍軍人,。”這正是支持退伍軍人事務部的人們長期以來的警告,，他們認為讓私營部門接管退伍軍人只能是這種結果,。

哈桑反駁說，診所根本沒能力治療慢性精神疾病患者或吸毒成癮住院治療的人,?！拔覀兲峁┒唐谛睦磲t(yī)療門診，主要是每周或每兩周一次的療程,。”他還補充說,，科恩網(wǎng)絡更希望填補現(xiàn)有系統(tǒng)的空白,，而不是替代。

2016年10月,，史蒂夫·科恩曾帶著《紐約時報》的攝影師前往診所,。一位發(fā)言人表示科恩“稱贊了南加州大學診所”，但在場的人印象并不一樣,。他們說,，科恩嫌診所規(guī)模太小，也不喜歡響鈴后才能進去就診（一種安全措施）,。他不喜歡診所周圍環(huán)境,。阿內特回憶稱，“他總是說：‘為什么不能這樣,？’‘為什么不能那樣,？’最后拍了幾張照片就走了，不到半小時,?！?

科恩表示不滿后，工作人員考慮將診所轉移到富人區(qū)帕薩迪納,，租金更貴,，客戶群體也不同。

2017年6月，哈桑發(fā)郵件告訴工作人員要關閉診所,，沒有任何解釋,。三位前臨床醫(yī)生和另外三名雇員表示，突然關閉導致一些患者治療過程中斷,。醫(yī)生表示有些患者剛剛完成服藥,，或經(jīng)歷創(chuàng)新式創(chuàng)傷治療。治療師只能告訴他們無法繼續(xù),。哈桑堅持說,，患者的治療均未受影響，如果有患者治療需延期,，南加州大學應該通知科恩網(wǎng)絡,。

治療師努力幫患者推薦其他診所以繼續(xù)治療，但并不是很好找,?？贫骶W(wǎng)絡用高級紙張打印出可選診所，治療師表示沒什么用,?！翱雌饋砭拖裼霉雀杷阉鳌迳即壭睦斫】怠缓筮x出前三名?！绷硪晃磺芭R床醫(yī)生表示,。

剛開始科恩網(wǎng)絡表示診所將重新開放，但數(shù)月過去并未重開,，到最后公司網(wǎng)站上已經(jīng)找不到洛杉磯,。“我們就這樣人間蒸發(fā)了,?！币晃磺肮蛦T說?！澳车卦\所說放棄就放棄,，患者怎么辦呢？最糟糕的是,，似乎沒有人關心,。“

科恩之所以參與退伍軍人醫(yī)療業(yè)務是出于個人原因：他的兒子羅伯特于2010年加入海軍陸戰(zhàn)隊并部署到阿富汗,?！皩Ω改竵碚f，這顯然是非?？膳碌氖虑??！笨贫髡f。 “現(xiàn)在他平安回來了,，但并不是每個退伍軍人都一樣,。”此前科恩只關注炒股,、收集藝術品,、花時間陪家人，還全力支持紐約洋基隊,。熟悉科恩的人士表示,，兒子當兵是改變他一生的經(jīng)歷。2013年科恩在紐約大學建立了第一個退伍軍人診所,。

同年,，他的對沖基金SAC承認從事內幕交易。檢察官盯了科恩近十年,，抓住了八名副手（雖然其中一些指控后來被推翻）,。一個案例中，一位交易員偷看了令人失望的臨床試驗結果,，影響兩家制藥公司,。科恩持有兩家公司7億美元的股票,。這位交易員打電話給科恩后,，科恩清算頭寸并投資2.6億美元賭股票下跌。臨床試驗結果公開后,，這筆交易為SAC凈賺約2.76億美元，這是有史以來內幕交易收益最高的一次,。

交易員馬修·馬爾托瑪服刑九年,，但拒絕指證科恩，因此檢察官無法證明他是否向科恩透露如何獲得信息,。檢察官只能起訴SAC公司,，沒法起訴科恩。美國證券交易委員會本想終身禁止科恩進入對沖基金行業(yè),，最終只判兩年禁入,。（這場貓捉老鼠的游戲還啟發(fā)了Showtime系列節(jié)目《億萬富翁》。）

科恩開設了一家新公司叫Point72,，最初是管理110億美元財產(chǎn)的家族辦公室,，后來開始為外部投資者管理資金。他打印了一份大海報上面是使命宣言和核心價值觀清單,，開頭就是“道德與誠信”,，然后讓員工簽名,。發(fā)言人赫爾表示，科恩聘請了55人的合規(guī)團隊,，有權限閱讀他所有電子郵件并可按常規(guī)限制交易,。“我們的合規(guī)和監(jiān)督部門在華爾街是最積極的,?！焙諣柋硎尽,！昂茈y有人比我們做得更到位,。”

非營利組織科恩退伍軍人網(wǎng)絡2016年正式成立,，員工在同一棟大樓內辦公,，穿得跟交易員差不多，只是偏羊絨衫風格,?！拔腋杏X像個投資經(jīng)理，只不過不賺錢只花錢,?！惫Ｔ嬖V彭博社記者?！拔覀兏杏X就是公司的一部分,。”

科恩在紐約大學啟動項目后,，紐約大學醫(yī)院系統(tǒng)的同名捐助者肯·朗格尼介紹他與精神病學系主任查理·邁爾邁,。邁爾邁曾在舊金山退伍軍人事務部工作21年，不僅了解心理健康診所,，也研究過創(chuàng)傷后應激障礙的生物體征,。邁爾邁的兩位同事回憶說，科恩和邁爾邁在科恩的格林威治大廈邊吃荷包蛋喝咖啡,，一邊交換意見,，墻上的畢加索真跡和衛(wèi)生間里的沃霍爾作品讓邁爾邁看得眼花繚亂。

正如項目相關研究人員介紹,，關鍵任務是找到“創(chuàng)傷后應激障礙各項試驗”：即通過血液檢查或腦部掃描診斷創(chuàng)傷后應激障礙,，而不僅依靠自行報告癥狀。更好地理解生物學也可能有助于準確診斷,。

一些專家不相信生物學測試可用于復雜的精神疾病,，如創(chuàng)傷后應激障礙。國防部和退伍軍人事務部已讓數(shù)百萬人加入創(chuàng)傷后應激障礙生物標記物測試,，未獲得明確結果,?！按蟛糠謺r間我們都在拼命睜大眼睛，祝大伙好運,?！?波士頓退伍軍人事務部創(chuàng)傷后應激障礙行為科學部國家中心主任特倫斯·基恩說，“為什么史蒂夫·科恩想把錢投到這塊,？”

在基恩看來,，還有許多值得研究的活動需要資金。如果能找到適合創(chuàng)傷后應激障礙的診斷測試,，就有明確的市場,。畢竟近百萬退伍軍人都要根據(jù)創(chuàng)傷后應激障礙的診斷接受政府補助。因此,，功能測試可以決定退伍軍人事務部應如何分配數(shù)十億美元,，并將幫其商業(yè)化的人賺很多錢。

科恩成立了第二家非營利組織負責該項,，名叫科恩退伍軍人生物科學公司,。據(jù)三位審查協(xié)議的人士透露，首席執(zhí)行官名叫馬加利·哈斯,，之前曾在制藥公司擔任高管,，而且已向研究人員發(fā)送合同要求簽署知識產(chǎn)權。

據(jù)一位出席此次談話的人士稱,，此舉引起與紐約大學研究人員和律師的沖突,，他們不喜歡科恩集團的收入分配方式,，或者說希望大學參與分享可能的額外收益,。紐約大學拒絕發(fā)表評論,。

近年來，基金會對支持研究商業(yè)應用的可行性越來越感興趣,。比爾和梅琳達·蓋茨基金會,、安德魯·梅隆基金會和麥克阿瑟基金會等主要慈善機構有時會保留資助發(fā)明的使用許可證，就像聯(lián)邦政府一樣,，同時確保相關發(fā)現(xiàn)對大眾有利。其他例如BrightFocus基金會等更深入一步,，希望資助發(fā)現(xiàn)后可收取一些特許使用費,。

但專家表示，基金會很少希望全面控制資助學術機構開發(fā)的知識產(chǎn)權,。大學通常表示反對,，因為自認更有資格利用知識產(chǎn)權推動研究并使公眾受益。由于基金會撥款通常不包括大學的所有成本,，包括管理費用等,，所以也不希望資助商業(yè)研究,。“有些行業(yè)利用此方式降低研究成本,，通過看似誘人的交易獲得技術所有權,。”約翰霍普金斯大學技術轉讓辦公室已退休的主任韋斯·布萊克斯利表示,。

參與項目的兩位人士稱,，知識產(chǎn)權方面出現(xiàn)分歧導致科恩停止資助邁爾邁研究。哈斯不同意,，他接受采訪時表示紐約大學之所以沒獲得更多資金,，主要原因是對原始撥款管理不善。隨后她發(fā)了一封電子郵件稱研究已結束,，因為紐約大學已經(jīng)找到研究對象,。

退出紐約大學后，科恩退伍軍人生物科學繼續(xù)找項目,，挖掘現(xiàn)有生物樣本和數(shù)據(jù)集,，資助頂尖研究人員。但一些科學家表示拒絕了科恩,，主要因為對知識產(chǎn)權安排不滿,。“全國很多科學家都很不滿,?！眹覄?chuàng)傷后應激障礙中心的基恩說?！瓣P鍵是他們總想著借機賺錢,，這就是為什么很多團體都不愿意與之合作?！?

哈斯表示,，科恩退伍軍人生物科學公司愿意與合作方分享知識產(chǎn)權，只是還在推敲細節(jié),?！拔覀兾ㄒ荒繕司褪窃噲D推動科學進步?！彼f,。她說，如果該組織真擁有新發(fā)明所有權,，授權制藥公司研發(fā),，所有收益也都會用于未來的研究。

科恩發(fā)言人馬克·赫爾說,，即便科恩退伍軍人生物科學公司的研究成功,，科恩也不會投資,。 “我們的立場類似政教分離，未來也不會變,?！?他在一份聲明中說。

兩位知情人士表示,，科恩剛開始與紐約大學,、朗格尼和紐約大學一位受托人，即美國國際集團前首席執(zhí)行官莫里斯·“漢克”·格林伯格合作時,，就明確告訴員工,，診所的目標就是打造退伍軍人事務部的替代?！袄矢窦{和格林伯格很想將退伍軍人事務部私有化,，推廣科恩診所的主要動機就是證明該理念?！币晃恢槿耸空f,。（格林伯格拒絕評論。朗格尼的女發(fā)言人將問題轉給紐約大學,，但紐約大學拒絕評論,。）

相關會議科恩均未出席，發(fā)言人表示科恩不支持將退伍軍人事務部私有化,，料想科恩網(wǎng)絡也不會變成范例,。

去年科恩著手游說國會和特朗普政府為治療退伍軍人補助診所。（2017年4月,，科恩為特朗普的就職典禮捐了100萬美元,，還為眾議院共和黨的超級政治行動委員會捐了100萬美元。）

從一開始科恩診所就宣傳看病免費,，但一直想辦法報銷治療費用,。根據(jù)科恩網(wǎng)絡網(wǎng)站公布信息，診所運營第四年時應從保險費,、當?shù)卮壬剖聵I(yè)和政府補助獲得25%資金,。到第六年比例上升到50%。在某些情況下,，向保險公司索賠也要向患者收取共同承擔費用,。

哈桑說，診所從不拒絕無錢看病的病人,。他稱爭取報銷是一種常識性解決方式，這樣才能擴大科恩的服務范圍,，使診所可持續(xù)發(fā)展,；與哈斯一樣,，他表示收入都應用于補償成本。

為了爭取政府報銷,，科恩還聯(lián)系了億萬富翁艾克·佩爾穆特,，他是漫威娛樂背后神秘的董事長，佩爾穆特曾向特朗普提出退伍軍人政策方面的非正式建議,。知情人士透露,，去年夏末科恩與佩爾穆特打了個電話，介紹了開科恩網(wǎng)絡的想法,。這位知情人士說,，佩爾穆特質疑為什么其他非營利組織都在精簡，科恩卻不限麻煩要開設實體診所,。該人士表示,，佩爾穆特警告當時擔任退伍軍人事務部秘書的大衛(wèi)·舒爾金，要小心科恩,。 （佩爾穆特的發(fā)言人拒絕評論,，舒爾金也沒有回復評論請求。）

科恩還找另一位人士幫忙,，杰夫·米勒在特朗普總統(tǒng)對退伍軍人事務部的立場方面影響很大,。作為眾議院退伍軍人委員會主席，米勒對退伍軍人事務部很不滿,，一直支持私人運作,。他是首批支持特朗普的議員之一，也成為退伍軍人問題的負責人,。2017年1月,，米勒離開國會加入一家大型律師事務所，第一個游說客戶就是史蒂夫·科恩,。

2017年9月,，科恩退伍軍人生物科學公司邀請全國各地的研究人員飛到華盛頓參加豪華的峰會，會上舒爾金發(fā)表了講話,，米勒也主持了小組討論,。一位與會者回憶說，在國家肖像畫廊舉辦的雞尾酒會上,，科恩在繩子隔開區(qū)域的保鏢身后走來走去,，不斷叫人過去聊天。峰會第二天,，在眾議院退伍軍人委員會聽證會上,，科恩退伍軍人生物科學公司為國會工作人員舉辦了簡報會。該公司還與兩家制藥聯(lián)盟，共同游說獲取退伍軍人事務部的數(shù)據(jù)和生物樣本,。

科恩的代表不斷向政府官員抱怨,，診所無法從退伍軍人事務部獲得報銷。在一次會議上,，退伍軍人組織的負責人糾正了米勒,，指出科恩網(wǎng)絡可以購買私營部門護理計劃（其實米勒曾協(xié)助創(chuàng)建該計劃）。但條件是每位患者都要獲得退伍軍人事務部預先批準,。米勒明確表示,，科恩網(wǎng)絡希望先給退伍軍人看病，再把費用賬單發(fā)給退伍軍人事務部,。

米勒開始爭取修改法律,，方便診所先看病再提交報銷。他的團隊訪問了眾議院退伍軍人委員會每間辦公室,，還起草了一項法案,，爭取讓退伍軍人事務部為前往私人心理健康診療機構就診（如科恩診所）的退伍軍人支付費用?！斑@是游說時可以參考的說法,。”他們給國會工作人員的電子郵件中寫道,。

游說者招募了各黨新議員支持其法案,，勸說對象均曾在海軍陸戰(zhàn)隊服役，游說者還努力爭取退伍軍人節(jié)前及時通過眾議院口頭表決,。

但該法案引起主要退伍軍人組織反對,。他們通常反對將退伍軍人事務部私有化，因為盡管最近丑聞不斷,，成員仍然支持該醫(yī)療系統(tǒng),。幾天后，退伍軍人事務部對該法案提出了多項疑問,，包括其中一項新設私人護理計劃與其他申請資格和資金相關法律存在沖突,。

米勒召集主要退伍軍人團體會面介紹該法案。退伍軍人團體同意組成統(tǒng)一戰(zhàn)線,，同時向民主黨共同發(fā)起人施加壓力,，要求其退出并勸其他議員也不要反對法案。米勒抓住機會反擊,，但2017年10月下旬,，退伍軍人組織出現(xiàn)在他俯瞰國會大廈的辦公室時，該法案已經(jīng)沒戲,。

This article is a collaboration between Fortune and ProPublica, a nonprofit investigative news organization.

At a House hearing last year on post-traumatic stress disorder, a private organization showed up with an ambitious plan to help suffering veterans. The Cohen Veterans Network was opening a chain of free mental health clinics across the country, backed by $275 million from hedge fund billionaire Steve Cohen.

By contrast to the high-profile scandals at the U.S. Department of Veterans Affairs, the Cohen Network claimed 96% client satisfaction. In a statement for the hearing, the organization said its clinics “provide a desirable alternative” to the VA—a clear echo of President Trump’s campaign promise to let veterans skip the VA for “a private service provider of their own choice.”

But at that same moment, across the country, the Cohen Network was closing its clinic in Los Angeles less than a year after it opened. The Cohen Network’s leaders had alienated the staff there, former employees said, by telling them to prioritize healthier patients over homeless veterans. The shutdown was so hasty that former therapists said it left some patients in the lurch.

Privatization has become the defining controversy at the VA under the Trump administration. Conservative billionaires such as the Koch brothers and Ken Langone want veterans to increasingly see private doctors, while traditional veterans organizations want to maintain the government-run health system.

The Cohen Network has become a test case for both sides. It is either proof that the private sector can do the job better than the VA—or a template for diverting taxpayer dollars to unaccountable private groups.

Steven Cohen is perhaps an unlikely person to find himself in the crossfire of this debate. He is best known as the billionaire hedge fund titan whose stock returns were the envy of Wall Street, until prosecutors busted his firm for insider trading. (Cohen, 62, was not personally charged; he declined to be interviewed for this article.) Since then, Cohen has launched a new hedge fund, called Point72, and opened 10 clinics serving veterans across the country. (For an in-depth look at how Cohen rebuilt his hedge fund business, see “Inside Billionaire Steve Cohen’s Comeback,” by Fortune‘s Jen Wieczner.)

A thorough examination of the Cohen Network’s record—including internal documents, emails and dozens of interviews with current and former employees—reveals a different story from the one the Cohen Network tells about itself. The clinic at the University of Southern California was doomed by the Cohen Network’s mismanagement and insistence on a narrow focus that helped only a subset of veterans, former employees said. “The model we ended up believing would really serve veterans was different than the model the Cohen Network was proposing all clinics operate under,” said Marv Southard, who served as CEO of the Cohen clinic at USC and is now chair of USC’s doctor of social work program.

The network’s original clinic, at New York University, got into a spat over who would own the patent rights from research that Cohen funded. And shortly after the hearing, Cohen mounted an aggressive lobbying campaign to get the government to subsidize the clinics.

The Cohen Network and Cohen’s own spokesman insist they’re not trying to privatize the VA and their only goal is helping veterans. “No single private person in this country has ever donated more money to save veterans’ lives and treat their mental health needs than Steve Cohen has,” Cohen’s spokesman, Mark Herr, said. The organization blames others for the problems in Los Angeles, New York, and Washington.

The story of the Cohen Network illustrates what could lie in store for veterans as Trump pursues his campaign pledge to place their care in the hands of the private sector.

When the Cohen Network opened the LA clinic in mid-2016, it attracted talented therapists with what appeared to be a rare opportunity to treat veterans as if money were no object. “It almost seemed too good to be true,” one of the clinicians said. “And, in fact, it was.”

The disappointment started as soon as the staff showed up. The clinic turned out to consist of a hallway shared with the dermatology department inside a USC facility. There were only three therapy rooms for six therapists; they were supposed to take turns and then walk to a different office several blocks away.

The next problem was the software for the patients’ medical records. Many of these systems are clunky, but clinicians said this one was the worst they’d ever used. They would fill out a long form and click submit, only to find their session had timed out and they had to start over. Session notes mysteriously vanished. “It was completely substandard compared to what we would have expected from this organization,” said Kathryn Arnett, the clinic’s director.

The Cohen Network’s CEO, Anthony Hassan, shot down complaints about the software, so staff across the network convened secret conference calls to troubleshoot, according to former employees. In written responses to questions, Hassan said it’s “absurd and untrue” that he lashed out at employees who spoke up about the software. He also denied it ever had problems, saying “there was no bug in the system.”

But a February 2017 internal review concluded otherwise: “There are ongoing clinical data errors in the system,” Cohen Network officials wrote.

Because of these problems, some current and former employees doubt the Cohen Network’s claims about its results. The client satisfaction survey, for example, was completed by only 6% of exiting patients, according to an October 2016 email from the network’s chief operating officer. The Cohen Network said the response rate has since risen to 59%. Still, that’s lower than typical for published studies and it means the score might not represent all patients’ views, particularly since there’s evidence that happier patients are more likely to complete the survey. (“We’re confident in the integrity of our data,” Hassan said, but he declined to elaborate on how they inspect and validate the data.)

The Cohen Network wanted more patients and was displeased with low turnout: An internal review found that the LA clinic, in its first six months, saw just 116 clients, which cost the clinic $10,282 each. “The average cost per client is very concerning, as is the low client count,” two executives wrote. Some of the clinicians had seen an emphasis on cost and volume at public agencies or cash-strapped nonprofits, but they struggled to understand such scrimping from the well-funded Cohen Network.

The Cohen Network’s focus on measurable outcomes influenced the care that the clinics would provide. Clinicians were supposed to use a set of six- to 15-week treatment programs that have been shown to help with PTSD, insomnia, depression, and anxiety.

But patients often have multiple conditions that don’t fit neatly into 12 weekly sessions. The Cohen Network’s limited scope led some other organizations that serve veterans to stop referring people there. “I didn’t think their model invested enough in engagement and after-care and focused too much on short-term intervention,” said Southard, who led the Los Angeles County Department of Mental Health for 17 years before becoming CEO of the Cohen clinic at USC. “The biggest disjuncture between USC’s vision and the Cohen network’s vision,” he said, “was we were aiming at people with more serious issues and problems and we needed a model that would serve them.”

The Cohen Network’s focus on measurable outcomes for PTSD led the LA clinic to shun some of the neediest patients. Because of the clinic’s location in a gritty part of downtown Los Angeles, many veterans who walked in were homeless. Homeless patients were hard to follow up with, which could be a drag on the clinic’s metrics. In an internal memo, Cohen officials chastised the staff for “targeting inappropriate client populations (e.g., transient/homeless, chronically mentally ill).”

Clinic staff were devastated. “All of us came here believing we were going to help the people who need us the most, and they said no,” said Arnett, the USC clinic’s director. “They weeded out the most compromised veterans.” This is exactly what the VA’s defenders have long warned would happen to veterans left to the private sector.

Hassan countered that the clinic simply wasn’t equipped to treat people with chronic mental illness or who needed inpatient treatment for drug addictions. “Our network provides short-term outpatient psychotherapeutic care delivered through weekly or biweekly sessions,” he said. The Cohen Network, he added, is intended to fill in gaps in the existing system, not to replace it.

Steve Cohen arrived to tour the clinic in October 2016, with a New York Timesphotographer in tow. A spokesman said Cohen was “impressed by the effort made by USC,” but people who were present recall it differently. Cohen didn’t like how small the clinic was, they said. He didn’t like that people needed to be buzzed in (a security measure). He didn’t like the neighborhood. As Arnett recalled it, “He said, ‘Why can’t we have this?’ and “Why isn’t it like that?’ He took a few pictures and stayed less than half an hour.”

In response to Cohen’s dissatisfaction, staff looked into moving the clinic to more affluent Pasadena, which would be more expensive and cater to a different kind of client.

In June 2017, Hassan emailed the staff to say the clinic was closing, with no explanation. The abrupt shutdown cut off some patients in the middle of treatment, according to three former clinicians and three other former employees. Clinicians said they had some patients who had just completed intake or opened up about a traumatic experience for the first time. The therapists had to tell them they couldn’t continue. For his part, Hassan insisted that no patient’s treatment was interrupted and that USC was supposed to tell the Cohen Network about any patients who needed their treatment to be extended.

The therapists tried to find referrals for all the patients to continue treatment elsewhere, but there wasn’t always another provider available. The Cohen Network sent a list of resources, printed on expensive paper, but the therapists said it wasn’t helpful. “It looked like someone had Googled ‘mental health Los Angeles’ and picked the top three results,” a third former clinician said.

The Cohen Network initially said the clinic would reopen, but as the months went by it never did, and eventually Los Angeles disappeared from the map on its website. “We just ghosted,” a former employee said. “We just split town, and what about all of these patients? The really bad part is, nobody seemed to care.”

*****

Cohen got involved in veterans’ health for the most personal of reasons: His son Robert joined the Marines and deployed to Afghanistan in 2010. It was “obviously, as a parent, a very scary thing,” Cohen has said. “Now, he came back, he’s fine, but not every vet is.” For Cohen—whose interests until that point were limited to trading stocks, collecting art, spending time with his family, and rooting for the New York Yankees—it was a life-changing experience, according to a person close to him. Cohen established his first veterans clinic at NYU in 2013.

That was the same year his hedge fund, SAC, pleaded guilty to insider trading. Prosecutors circled Cohen for almost a decade, nabbing eight of his lieutenants (although some of those convictions were later overturned). In one case, a trader got a sneak peek at discouraging clinical trial results affecting two pharmaceutical companies. Cohen had $700 million riding on those stocks. The trader called Cohen, who then liquidated his position and bet $260 million that the stocks would fall. When the results of the clinical trial became public, the trade netted SAC about $276 million, the biggest profit from insider trading ever.

The trader, Mathew Martoma, is serving a nine-year sentence, but he refused to testify against Cohen, so prosecutors could not prove whether or not he told Cohen anything about how he got his information. They indicted SAC as a company, but not Cohen personally. The Securities and Exchange Commission sought to ban Cohen from the hedge fund industry for life, but settled on a two-year hiatus. (This cat-and-mouse game loosely inspired the Showtime series “Billions.”)

Cohen opened a firm, called Point72, which was initially a family office that managed his own $11 billion fortune, and has since begun to manage money for outside investors. He printed a mission statement and list of core values—starting with “Ethics & Integrity”—on a big poster for the staff to sign. He hired a 55-person compliance team that now reads all of his emails and routinely restricts trades, according to Herr, Cohen’s spokesman. “We have the most aggressive compliance and surveillance department on Wall Street,” Herr said. “It would be hard to have done more than we have.”

The staff of the nonprofit Cohen Veterans Network, which was formally launched in 2016, works in the same building, outfitted like the traders in branded fleeces. “It’s almost as if I’m one of the portfolio managers. I’m just not making money, I’m spending money,” Hassan once told a Bloomberg reporter. “We very much feel part of the firm.”

Cohen got started at NYU when Ken Langone, the name donor of the university’s hospital system, connected him with Charlie Marmar, the chair of the psychiatry department. Marmar, who’d spent 21 years at the San Francisco VA, had an idea not only for a mental health clinic but for research on the biological signs of PTSD. Cohen and Marmar discussed the vision over poached eggs and coffee at Cohen’s Greenwich mansion, where Cohen dazzled Marmar with the Picassos on the walls and the Warhol in the bathroom, two of Marmar’s colleagues recalled.

The mission, as one researcher involved in the project described it, was to find a “pregnancy test for PTSD”: a blood test or a brain scan that could be used to diagnose PTSD, rather than relying on self-reported symptoms. Better understanding the biology might also lead to more effective treatments.

Some experts were skeptical that a biological test could work for a complex and varied psychiatric condition like PTSD. The Departments of Defense and Veterans Affairs had already sunk millions into pursuing PTSD biomarkers, with little to show for it. “We mostly rolled our eyes and said good luck,” said Terence Keane, director of the National Center for PTSD’s Behavioral Science Division at the Boston VA. “Why would that be what Steve Cohen wanted to put his money into?”

In Keane’s view, there were many more deserving research endeavors in need of funding. Still, a diagnostic test for PTSD, if one could be found, would have a clear market. Nearly a million veterans receive government checks based on a diagnosis of PTSD. So a functional test could decide how the VA distributes billions of dollars—and make a lot of money for whoever commercialized it.

Cohen launched a second nonprofit organization, called Cohen Veterans Bioscience, to lead the research. Its CEO, a former pharmaceutical executive named Magali Haas, sent researchers contracts asking them to sign over intellectual property rights, according to three people who reviewed the agreements.

That caused friction with NYU researchers and lawyers, who objected to what they viewed as the Cohen group’s revenue grab—or wanted the university to share in the possible windfall, according to a person present for conversations on this point. NYU declined to comment.

In recent years, foundations have shown increasing interest in possible commercial applications of research they support. Major philanthropies, such as the Bill & Melinda Gates Foundation, the Andrew W. Mellon Foundation and the MacArthur Foundation sometimes retain a license to use inventions they’ve funded, much as the federal government does, while working to ensure that the discoveries benefit the public. Others, like the BrightFocus Foundation, have pushed further, seeking royalties from discoveries they fund.

But it’s rare, experts say, for foundations to seek total control over intellectual property developed by the academics whose work they fund. Universities typically object because they consider themselves more qualified to use the IP to advance research and benefit the public. And since foundation grants typically don’t cover universities’ full costs including overhead, they don’t want to be in the position of subsidizing commercial research. “There were cases where industry was using this as a ploy to get a lower rate on research costs and get ownership of technology in a sweetheart deal,” said Wes Blakeslee, the retired director of the Johns Hopkins University Technology Transfer Office.

The disagreement over intellectual property led Cohen to stop funding Marmar’s research, according to two people involved in the project. Haas disputed that, saying in an interview that NYU didn’t get more money because it mismanaged the original grant. She then followed up with an email, this time saying the study ended because NYU finished recruiting subjects.

Cohen Veterans Bioscience moved on from NYU, scooping up existing biological samples and datasets, and funding top researchers. But some scientists said they turned down Cohen out of discomfort with the IP arrangements. “They have offended many people across the country,” said Keane of the National Center for PTSD. “The undercurrent is they’re trying to get a silver bullet to make money, and that’s why a lot of groups are not collaborating with them.”

Haas said Cohen Veterans Bioscience shares intellectual property rights with collaborators, but they’re still hammering out the details. “The only thing we’re interested in is trying to move the science forward,” she said. If the organization did have rights to an invention that it could license to a drug company to develop, she said, all the proceeds would fund future research.

Cohen’s spokesman, Mark Herr, said Cohen won’t invest in anything that arises from Cohen Veterans Bioscience’s work. “We maintain a church and state separation between the two, and that will not change in the future,” he said in a statement.

*****

When Cohen started his collaboration with NYU, Langone and a fellow NYU trustee, former AIG CEO Maurice “Hank” Greenberg, told faculty members that the goal of the clinic was to create a private alternative to the VA, according to two people familiar with the discussions. “Langone and Greenberg were really into privatizing the VA, and the big motivation behind the Cohen clinic was to be proof of concept,” one of the people said. (Greenberg declined to comment. Langone’s spokeswoman referred questions to NYU, which declined to comment.)

Cohen wasn’t present for those meetings, and his spokesman said he doesn’t support privatizing the VA or envision the Cohen Network as a model for doing so.

Last year, Cohen set out to persuade Congress and the Trump administration to reimburse his clinics for veterans treated there. (Cohen contributed $1 million to Trump’s inauguration and another $1 million to the House Republicans’ super PAC in April 2017.)

From the beginning, the Cohen clinics were advertised as free to patients, but the plan was always to start seeking reimbursement for their treatment. By their fourth year in operation, clinics are supposed to supply 25% of their own funding from insurance reimbursements, local philanthropy, and government grants, according to information posted on the Cohen Network’s website. That figure rises to 50% by year six. In some cases, billing insurers also requires charging copays from patients.

Hassan said the clinics never turn away patients who can’t pay. He called collecting reimbursements a common-sense way to extend the reach of Cohen’s gift and make the clinics sustainable; like Haas, he said any revenues would be used to offset costs.

As part of his pursuit of government reimbursements, Cohen contacted fellow billionaire Ike Perlmutter, the enigmatic Marvel Entertainment chairman who has unofficially advised Trump on veterans policy. Cohen had a phone call with Perlmutter late last summer to sell him on the network, according to a person familiar with the call. Perlmutter questioned why Cohen would go to so much trouble to open brick-and-mortar clinics when other nonprofit organizations have leaner models, the person said. According to this person, Perlmutter warned then-VA secretary David Shulkin to be careful with Cohen. (Perlmutter’s representative declined to comment, and Shulkin didn’t answer requests for comment.)

Cohen also sought advice from a person who shaped President Trump’s position on the VA: Jeff Miller. As chairman of the House veterans committee, Miller had been a harsh critic of the VA and promoter of private alternatives. He was one of the first lawmakers to endorse Trump and became the candidate’s point man on veterans issues. After Miller retired from Congress in January 2017 and joined a big law firm, his first lobbying client was Steve Cohen.

In September 2017, Cohen Veterans Bioscience flew researchers from around the country to a lavish summit in Washington, featuring a speech by Shulkin and a panel moderated by Miller. At a cocktail party at the National Portrait Gallery, Cohen lingered behind bouncers in a roped-off area, summoning people he wanted to talk to, an attendee recalls. A day after the summit, Cohen Veterans Bioscience held a briefing for congressional staff in the House veterans committee hearing room. Cohen Veterans Bioscience also joined a coalition with two pharmaceutical companies to lobby for access to VA datasets and biological samples.

Cohen’s representatives repeatedly complained to government officials that his clinics couldn’t get reimbursements from the VA. In one meeting, the leader of a veterans organization corrected Miller, pointing out that the Cohen Network could, in fact, enroll in a program for buying private-sector care (a program Miller had actually helped create). But that would require each patient to obtain advance approval from the VA. Miller made clear that the Cohen Network wanted to see the veteran first, then send the VA the bill.

Miller set out to change the law to let the clinics do exactly that. His team visited the office of every member of the House veterans committee and drafted a bill to let the VA pay for veterans who walk in to private mental health providers like the Cohen clinics. “Here is language to get you started,” they wrote in an email to congressional staff.

The lobbyists recruited a freshman lawmaker from each party, both former Marines, to sponsor their bill and tried to rush it through the House on a voice vote in time for Veterans Day.

But the bill raised objections from major veterans organizations. They generally oppose privatizing the VA because the health system remains popular with their members despite recent scandals. A few days later, the VA weighed in with more than a dozen concerns about the bill, including that it carved out a new private-care program conflicting with other laws on eligibility and funding.

Miller called a meeting with the major veterans groups to brief them on the bill. The veterans groups agreed among themselves to present a united front. Meanwhile, they pressured the Democratic cosponsor to drop out and waved other lawmakers off the bill. Miller caught wind of the counterattack, but by the time the veterans organizations showed up at his office overlooking the Capitol in late October 2017, the bill was dead.

雖然在國會受挫,，但米勒與特朗普政府打交道時情況好些,。他與退伍軍人事務部高級官員聯(lián)系，希望與科恩網(wǎng)絡建立合作伙伴關系,。2017年10月順利簽署一項協(xié)議，除了共享已經(jīng)公開的數(shù)據(jù)之外沒什么其他內容,。退伍軍人事務部也與其他機構簽訂了大量類似協(xié)議,。

但協(xié)議簽署后不久，科恩的代表提出了診所報銷的問題,。一位前官員表示,，退伍軍人事務部官員感到被騙了。

退伍軍人團體和一些議員在發(fā)現(xiàn)合伙關系時都表示懷疑,?？贫骶W(wǎng)絡“必須對組織架構和遵守聯(lián)邦法律保持透明”，3月5日,，眾議院和參議院退伍軍人委員會的民主黨高層寫信給舒爾金,，要求提供更多信息。

然而,，科恩網(wǎng)絡成功獲準向退伍軍人事務部獲得報銷,。科恩網(wǎng)絡一位負責人對報銷金額相當看不上,，稱目前才有500美元,。

但米勒的游說活動之后，沒怎么安撫退伍軍人事務部醫(yī)療系統(tǒng)的支持者,。另一名退伍軍人事務部前官員表示：“問題在于政府能花在退伍軍人醫(yī)療方面的資金只有這么點,。如果開始投給科恩退伍軍人網(wǎng)絡之類機構，實際上就是私有化,?？隙〞飧鞣角У度f剮式的譴責?！?

抵制科恩診所的活動令科恩感到不安,，他認為自己在努力提供積極的影響?！笆返俜颉た贫髟趲兔斶€我們對退伍軍人的虧欠,。”科恩的發(fā)言人赫爾說,，“如果有人懷疑或譴責他的慷慨之舉,，是很可恥的。”

科恩沒有被嚇倒,。該網(wǎng)絡剛剛開設了第10家診所,，還計劃2020年之前增至25家。赫爾表示,，科恩認為該網(wǎng)絡比較成功,，而且正考慮提升資助金額，超過之前承諾的2.75億美元,。（財富中文網(wǎng)）

譯者：Feb?

Thwarted in Congress, Miller fared better with the Trump administration. He contacted senior VA officials in the hopes of forming a partnership with the Cohen Network. They signed an agreement in October 2017 that didn’t offer much other than to share data that was already publicly available. The VA has scores of similar agreements with other organizations.

But soon after the agreement was in place, Cohen’s representatives raised the issue of getting reimbursements for the clinics. That made VA officials feel tricked, according to a former agency official.

Veterans groups and some lawmakers were suspicious when they found out about the partnership. The Cohen Network “must be transparent about its organization and compliance with federal law,” the top Democrats on the House and Senate veterans committees wrote in a March 5 letter to Shulkin demanding more information.

Nevertheless, the Cohen Network succeeded in getting approved to receive reimbursements from the VA. A Cohen Network official downplays the payments, saying they’ve amounted to $500 so far.

But after Miller’s lobbying campaign, that does little to reassure defenders of the VA’s healthcare system. “The problem is there’s only so much government money in veterans’ care,” another former VA official said. “If you start trying to carve into that to feed things like the Cohen Veterans Network, that’s actually privatization. It’s going to be death by a thousand cuts.”

The resistance to the Cohen clinics is vexing for Cohen, who believes he’s trying to make a positive impact. “Steve Cohen is helping repay the debt we owe our veterans,” said his spokesman, Herr, “and it is shameful that anyone doubts or impugns his generosity.”

Cohen is undeterred. The network just opened its 10th clinic and plans to have 25 by 2020. Cohen believes the network is succeeding, Herr said, and is considering expanding his support beyond the $275 million he’s already committed.