本文由《财富》杂志与非营利调查新闻机构ProPublica合作完成。

在去年一场创伤后应激障碍的众议院听证会上，一家私人机构提出了雄心勃勃的计划帮助受疾病困扰的退伍军人。科恩退伍军人网络打算在美国多地开设免费的心理健康诊所，主要靠对冲基金亿万富翁史蒂夫·科恩捐出的2.75亿美元资金支持。

与经常曝出丑闻的美国退伍军人事务部相比，科恩网络称客户满意度达96%。在一份听证会声明中，该组织表示网络各诊所“为解决退伍军人问题提供了理想的选择” ，这也是明确回应特朗普大选时的承诺，即让退伍军人跳过退伍军人事务部，转而选择“私人服务提供商”。

言犹在耳，科恩网络在洛杉矶的诊所却开业不到一年就关闭了。前雇员说，公司管理层曾让员工优先考虑更健康的病人而不是无家可归的退伍军人，双方早已出现隔阂。但关闭的决定非常突然，前治疗师表示，一些病人非常失望。

在特朗普政府执政期间，私有化成为退伍军人事务部的争议焦点。科氏兄弟和肯·朗格尼等保守派亿万富翁希望退伍军人尽可能去看私人医生，而传统的退伍军人组织希望政府继续负责医疗系统。

科恩网络已成为双方的测试案例。要么证明私营部门能比退伍军人事务部更高效完成工作，要么变成纳税人资金转移到不靠谱私人机构的范例。

史蒂文·科恩可能还没注意自己身处交火中心。他最出名的身份是亿万富翁对冲基金巨头，股票回报令全华尔街羡慕，后来联邦检察官以内幕交易为由突击搜查了他的公司。（62岁的科恩未受到指控；他拒绝接受本文作者采访。）之后，科恩成立了一只新对冲基金Point72，还在全国开设了10家诊所为退伍军人服务。

彻底检查科恩网络各项记录后，包括内部文件、电子邮件和对现任和前任员工的数十次采访，呈现出与该公司讲述完全不同的故事。前雇员表示，南加州大学诊所之所以最终关闭，主要因为科恩网络管理不善，而且对象比较窄，只能照顾一小部分退伍军人。“我们最终找到真正能帮到退伍军人的模式与科恩网络诊所的模式并不一样。”马弗·萨瑟德表示，他曾担任南加州大学科恩诊所首席执行官，现任南加州大学医生社会工作项目的主席。

科恩网络最早在纽约大学成立的诊所也遇到了麻烦，原因是对科恩资助的研究专利权产生纠纷。听证会结束后不久，科恩积极开展游说，希望政府出手补贴诊所。

科恩网络和科恩的发言人坚称从未想把退伍军人事务部私有化，唯一的目标就是帮助退伍军人。科恩的发言人马克·赫尔表示：“在美国，再没人比科恩更积极出钱拯救退伍军人的生命，满足退伍军人的精神需求。”科恩网络认为在洛杉矶、纽约和华盛顿出现的问题都是别人的原因。

从科恩网络的故事可以看出，特朗普为实现竞选承诺让私营部门负责退伍军人，究竟意味着什么。

2016年年中，科恩网络在洛杉矶开设诊所，吸引了不少优秀的治疗师，因为钱似乎不是问题，是难得的给退伍军人治病机会。“简直太完美，都不像真的。”一位临床医生说。 “回过头看确实不是真的。”

工作人员刚就位就开始感到失望。原来该诊所在南加州大学里，只有条走廊，还跟皮肤科共享。六位治疗师只有三间治疗室，只能轮流问诊，到另一处办公室还得步行几个街区。

另一个问题是储存患者病历的软件。市面上很多系统都不好用，但临床医生都表示该系统堪称最差。他们经常写长文提交后发现会话超时，不得不重新开始。会话填写的笔记也会神秘地消失。“完全达不到之前的预期。”诊所主任凯瑟琳·阿内特表示。

据前雇员透露，科恩网络首席执行官安东尼·哈桑坚决否认软件收到投诉，所以工作人员只能私下开电话会议排除故障。哈桑书面回答问题时表示，指责他骂员工讨论软件“荒谬虚假”。他还否认软件出过问题，他说“系统里没有漏洞。”

但2017年2月内部审查结论是：“系统里持续存在临床数据错误。”科恩网络的高层写道。

由于问题层出不穷，一些现任和前任员工怀疑科恩网络公布的结果。举例来说，该网络首席运营官于2016年10月在一封电子邮件中称，客户满意度调查仅由6%的现有患者完成。科恩网络称，回应率已上升至59%。尽管如此，该比例仍低于已发表研究的普遍比例，也说明最终打分可能并不代表所有患者的观点，而且有证据表明心情愉快的患者完成调查的几率更高。（“我们对数据的完整性充满信心。”哈桑说，但他拒绝解释如何检查和验证数据。）

科恩网络需要更多的患者，对投票率低也很不满：一项内部审查发现，前六个月洛杉矶诊所仅有116名客户，每个客户的成本为10,282美元。“平均成本水平非常令人担心，客户数量少也让人不安。”两位高管写道。一些临床医生发现公共机构或现金拮据的非营利组织比较注重成本和数量，但资金充足的科恩网络如此吝啬令人不解。

科恩网络过于注重可测量的结果，影响了诊所提供的治疗服务。临床医生应该采用一套有助于创伤后应激障碍、失眠、抑郁和焦虑的治疗方案，为期6到15周。

但患者通常有多种情况，并不一定适合12周疗程。由于科恩网络治疗范围有限，其他一些服务退伍军人服务不再推荐。“他们的模式在参与和后续护理方面投入不够，而且过于注重短期干预。”萨瑟德表示，担任科恩诊所首席执行官之前他曾负责洛杉矶县精神卫生部门17年。 “南加州大学与科恩网络愿景之间最大的分歧，”他说，“在于我们的目标是问题很严重且困难很大的病人，而且要找到能提供帮助的模式。”

由于科恩网络更关注创伤后应激障碍的可测量结果，洛杉矶诊所回绝了一些需求急迫的患者。由于诊所位于洛杉矶市中心贫民区，许多就诊的退伍军人无家可归。无家可归者很难跟进治疗，可能会拖累诊所的指标。在一份内部备忘录中，科恩网络的负责人就曾批评员工“接待不合适的客户群（例如，暂住者/无家可归者，长期精神病患者）。”

诊所的工作人员很受打击。“我们来到这里都以为可以帮助最需要的人，负责人却说不能帮。”南加州大学诊所的主任阿内特说。“他们赶走了情况最差的退伍军人。”这正是支持退伍军人事务部的人们长期以来的警告，他们认为让私营部门接管退伍军人只能是这种结果。

哈桑反驳说，诊所根本没能力治疗慢性精神疾病患者或吸毒成瘾住院治疗的人。“我们提供短期心理医疗门诊，主要是每周或每两周一次的疗程。”他还补充说，科恩网络更希望填补现有系统的空白，而不是替代。

2016年10月，史蒂夫·科恩曾带着《纽约时报》的摄影师前往诊所。一位发言人表示科恩“称赞了南加州大学诊所”，但在场的人印象并不一样。他们说，科恩嫌诊所规模太小，也不喜欢响铃后才能进去就诊（一种安全措施）。他不喜欢诊所周围环境。阿内特回忆称，“他总是说：‘为什么不能这样？’‘为什么不能那样？’最后拍了几张照片就走了，不到半小时。”

科恩表示不满后，工作人员考虑将诊所转移到富人区帕萨迪纳，租金更贵，客户群体也不同。

2017年6月，哈桑发邮件告诉工作人员要关闭诊所，没有任何解释。三位前临床医生和另外三名雇员表示，突然关闭导致一些患者治疗过程中断。医生表示有些患者刚刚完成服药，或经历创新式创伤治疗。治疗师只能告诉他们无法继续。哈桑坚持说，患者的治疗均未受影响，如果有患者治疗需延期，南加州大学应该通知科恩网络。

治疗师努力帮患者推荐其他诊所以继续治疗，但并不是很好找。科恩网络用高级纸张打印出可选诊所，治疗师表示没什么用。“看起来就像用谷歌搜索‘洛杉矶心理健康’然后选出前三名。”另一位前临床医生表示。

刚开始科恩网络表示诊所将重新开放，但数月过去并未重开，到最后公司网站上已经找不到洛杉矶。“我们就这样人间蒸发了。”一位前雇员说。“某地诊所说放弃就放弃，患者怎么办呢？最糟糕的是，似乎没有人关心。“

科恩之所以参与退伍军人医疗业务是出于个人原因：他的儿子罗伯特于2010年加入海军陆战队并部署到阿富汗。“对父母来说，这显然是非常可怕的事情。”科恩说。 “现在他平安回来了，但并不是每个退伍军人都一样。”此前科恩只关注炒股、收集艺术品、花时间陪家人，还全力支持纽约洋基队。熟悉科恩的人士表示，儿子当兵是改变他一生的经历。2013年科恩在纽约大学建立了第一个退伍军人诊所。

同年，他的对冲基金SAC承认从事内幕交易。检察官盯了科恩近十年，抓住了八名副手（虽然其中一些指控后来被推翻）。一个案例中，一位交易员偷看了令人失望的临床试验结果，影响两家制药公司。科恩持有两家公司7亿美元的股票。这位交易员打电话给科恩后，科恩清算头寸并投资2.6亿美元赌股票下跌。临床试验结果公开后，这笔交易为SAC净赚约2.76亿美元，这是有史以来内幕交易收益最高的一次。

交易员马修·马尔托玛服刑九年，但拒绝指证科恩，因此检察官无法证明他是否向科恩透露如何获得信息。检察官只能起诉SAC公司，没法起诉科恩。美国证券交易委员会本想终身禁止科恩进入对冲基金行业，最终只判两年禁入。（这场猫捉老鼠的游戏还启发了Showtime系列节目《亿万富翁》。）

科恩开设了一家新公司叫Point72，最初是管理110亿美元财产的家族办公室，后来开始为外部投资者管理资金。他打印了一份大海报上面是使命宣言和核心价值观清单，开头就是“道德与诚信”，然后让员工签名。发言人赫尔表示，科恩聘请了55人的合规团队，有权限阅读他所有电子邮件并可按常规限制交易。“我们的合规和监督部门在华尔街是最积极的。”赫尔表示。“很难有人比我们做得更到位。”

非营利组织科恩退伍军人网络2016年正式成立，员工在同一栋大楼内办公，穿得跟交易员差不多，只是偏羊绒衫风格。“我感觉像个投资经理，只不过不赚钱只花钱。”哈桑曾告诉彭博社记者。“我们感觉就是公司的一部分。”

科恩在纽约大学启动项目后，纽约大学医院系统的同名捐助者肯·朗格尼介绍他与精神病学系主任查理·迈尔迈。迈尔迈曾在旧金山退伍军人事务部工作21年，不仅了解心理健康诊所，也研究过创伤后应激障碍的生物体征。迈尔迈的两位同事回忆说，科恩和迈尔迈在科恩的格林威治大厦边吃荷包蛋喝咖啡，一边交换意见，墙上的毕加索真迹和卫生间里的沃霍尔作品让迈尔迈看得眼花缭乱。

正如项目相关研究人员介绍，关键任务是找到“创伤后应激障碍各项试验”：即通过血液检查或脑部扫描诊断创伤后应激障碍，而不仅依靠自行报告症状。更好地理解生物学也可能有助于准确诊断。

一些专家不相信生物学测试可用于复杂的精神疾病，如创伤后应激障碍。国防部和退伍军人事务部已让数百万人加入创伤后应激障碍生物标记物测试，未获得明确结果。“大部分时间我们都在拼命睁大眼睛，祝大伙好运。” 波士顿退伍军人事务部创伤后应激障碍行为科学部国家中心主任特伦斯·基恩说，“为什么史蒂夫·科恩想把钱投到这块？”

在基恩看来，还有许多值得研究的活动需要资金。如果能找到适合创伤后应激障碍的诊断测试，就有明确的市场。毕竟近百万退伍军人都要根据创伤后应激障碍的诊断接受政府补助。因此，功能测试可以决定退伍军人事务部应如何分配数十亿美元，并将帮其商业化的人赚很多钱。

科恩成立了第二家非营利组织负责该项，名叫科恩退伍军人生物科学公司。据三位审查协议的人士透露，首席执行官名叫马加利·哈斯，之前曾在制药公司担任高管，而且已向研究人员发送合同要求签署知识产权。

据一位出席此次谈话的人士称，此举引起与纽约大学研究人员和律师的冲突，他们不喜欢科恩集团的收入分配方式，或者说希望大学参与分享可能的额外收益。纽约大学拒绝发表评论。

近年来，基金会对支持研究商业应用的可行性越来越感兴趣。比尔和梅琳达·盖茨基金会、安德鲁·梅隆基金会和麦克阿瑟基金会等主要慈善机构有时会保留资助发明的使用许可证，就像联邦政府一样，同时确保相关发现对大众有利。其他例如BrightFocus基金会等更深入一步，希望资助发现后可收取一些特许使用费。

但专家表示，基金会很少希望全面控制资助学术机构开发的知识产权。大学通常表示反对，因为自认更有资格利用知识产权推动研究并使公众受益。由于基金会拨款通常不包括大学的所有成本，包括管理费用等，所以也不希望资助商业研究。“有些行业利用此方式降低研究成本，通过看似诱人的交易获得技术所有权。”约翰霍普金斯大学技术转让办公室已退休的主任韦斯·布莱克斯利表示。

参与项目的两位人士称，知识产权方面出现分歧导致科恩停止资助迈尔迈研究。哈斯不同意，他接受采访时表示纽约大学之所以没获得更多资金，主要原因是对原始拨款管理不善。随后她发了一封电子邮件称研究已结束，因为纽约大学已经找到研究对象。

退出纽约大学后，科恩退伍军人生物科学继续找项目，挖掘现有生物样本和数据集，资助顶尖研究人员。但一些科学家表示拒绝了科恩，主要因为对知识产权安排不满。“全国很多科学家都很不满。”国家创伤后应激障碍中心的基恩说。“关键是他们总想着借机赚钱，这就是为什么很多团体都不愿意与之合作。”

哈斯表示，科恩退伍军人生物科学公司愿意与合作方分享知识产权，只是还在推敲细节。“我们唯一目标就是试图推动科学进步。”她说。她说，如果该组织真拥有新发明所有权，授权制药公司研发，所有收益也都会用于未来的研究。

科恩发言人马克·赫尔说，即便科恩退伍军人生物科学公司的研究成功，科恩也不会投资。 “我们的立场类似政教分离，未来也不会变。” 他在一份声明中说。

两位知情人士表示，科恩刚开始与纽约大学、朗格尼和纽约大学一位受托人，即美国国际集团前首席执行官莫里斯·“汉克”·格林伯格合作时，就明确告诉员工，诊所的目标就是打造退伍军人事务部的替代。“朗格纳和格林伯格很想将退伍军人事务部私有化，推广科恩诊所的主要动机就是证明该理念。”一位知情人士说。（格林伯格拒绝评论。朗格尼的女发言人将问题转给纽约大学，但纽约大学拒绝评论。）

相关会议科恩均未出席，发言人表示科恩不支持将退伍军人事务部私有化，料想科恩网络也不会变成范例。

去年科恩着手游说国会和特朗普政府为治疗退伍军人补助诊所。（2017年4月，科恩为特朗普的就职典礼捐了100万美元，还为众议院共和党的超级政治行动委员会捐了100万美元。）

从一开始科恩诊所就宣传看病免费，但一直想办法报销治疗费用。根据科恩网络网站公布信息，诊所运营第四年时应从保险费、当地慈善事业和政府补助获得25%资金。到第六年比例上升到50%。在某些情况下，向保险公司索赔也要向患者收取共同承担费用。

哈桑说，诊所从不拒绝无钱看病的病人。他称争取报销是一种常识性解决方式，这样才能扩大科恩的服务范围，使诊所可持续发展；与哈斯一样，他表示收入都应用于补偿成本。

为了争取政府报销，科恩还联系了亿万富翁艾克·佩尔穆特，他是漫威娱乐背后神秘的董事长，佩尔穆特曾向特朗普提出退伍军人政策方面的非正式建议。知情人士透露，去年夏末科恩与佩尔穆特打了个电话，介绍了开科恩网络的想法。这位知情人士说，佩尔穆特质疑为什么其他非营利组织都在精简，科恩却不限麻烦要开设实体诊所。该人士表示，佩尔穆特警告当时担任退伍军人事务部秘书的大卫·舒尔金，要小心科恩。 （佩尔穆特的发言人拒绝评论，舒尔金也没有回复评论请求。）

科恩还找另一位人士帮忙，杰夫·米勒在特朗普总统对退伍军人事务部的立场方面影响很大。作为众议院退伍军人委员会主席，米勒对退伍军人事务部很不满，一直支持私人运作。他是首批支持特朗普的议员之一，也成为退伍军人问题的负责人。2017年1月，米勒离开国会加入一家大型律师事务所，第一个游说客户就是史蒂夫·科恩。

2017年9月，科恩退伍军人生物科学公司邀请全国各地的研究人员飞到华盛顿参加豪华的峰会，会上舒尔金发表了讲话，米勒也主持了小组讨论。一位与会者回忆说，在国家肖像画廊举办的鸡尾酒会上，科恩在绳子隔开区域的保镖身后走来走去，不断叫人过去聊天。峰会第二天，在众议院退伍军人委员会听证会上，科恩退伍军人生物科学公司为国会工作人员举办了简报会。该公司还与两家制药联盟，共同游说获取退伍军人事务部的数据和生物样本。

科恩的代表不断向政府官员抱怨，诊所无法从退伍军人事务部获得报销。在一次会议上，退伍军人组织的负责人纠正了米勒，指出科恩网络可以购买私营部门护理计划（其实米勒曾协助创建该计划）。但条件是每位患者都要获得退伍军人事务部预先批准。米勒明确表示，科恩网络希望先给退伍军人看病，再把费用账单发给退伍军人事务部。

米勒开始争取修改法律，方便诊所先看病再提交报销。他的团队访问了众议院退伍军人委员会每间办公室，还起草了一项法案，争取让退伍军人事务部为前往私人心理健康诊疗机构就诊（如科恩诊所）的退伍军人支付费用。“这是游说时可以参考的说法。”他们给国会工作人员的电子邮件中写道。

游说者招募了各党新议员支持其法案，劝说对象均曾在海军陆战队服役，游说者还努力争取退伍军人节前及时通过众议院口头表决。

但该法案引起主要退伍军人组织反对。他们通常反对将退伍军人事务部私有化，因为尽管最近丑闻不断，成员仍然支持该医疗系统。几天后，退伍军人事务部对该法案提出了多项疑问，包括其中一项新设私人护理计划与其他申请资格和资金相关法律存在冲突。

米勒召集主要退伍军人团体会面介绍该法案。退伍军人团体同意组成统一战线，同时向民主党共同发起人施加压力，要求其退出并劝其他议员也不要反对法案。米勒抓住机会反击，但2017年10月下旬，退伍军人组织出现在他俯瞰国会大厦的办公室时，该法案已经没戏。

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.

虽然在国会受挫，但米勒与特朗普政府打交道时情况好些。他与退伍军人事务部高级官员联系，希望与科恩网络建立合作伙伴关系。2017年10月顺利签署一项协议，除了共享已经公开的数据之外没什么其他内容。退伍军人事务部也与其他机构签订了大量类似协议。

但协议签署后不久，科恩的代表提出了诊所报销的问题。一位前官员表示，退伍军人事务部官员感到被骗了。

退伍军人团体和一些议员在发现合伙关系时都表示怀疑。科恩网络“必须对组织架构和遵守联邦法律保持透明”，3月5日，众议院和参议院退伍军人委员会的民主党高层写信给舒尔金，要求提供更多信息。

然而，科恩网络成功获准向退伍军人事务部获得报销。科恩网络一位负责人对报销金额相当看不上，称目前才有500美元。

但米勒的游说活动之后，没怎么安抚退伍军人事务部医疗系统的支持者。另一名退伍军人事务部前官员表示：“问题在于政府能花在退伍军人医疗方面的资金只有这么点。如果开始投给科恩退伍军人网络之类机构，实际上就是私有化。肯定会遭各方千刀万剐式的谴责。”

抵制科恩诊所的活动令科恩感到不安，他认为自己在努力提供积极的影响。“史蒂夫·科恩在帮忙偿还我们对退伍军人的亏欠。”科恩的发言人赫尔说，“如果有人怀疑或谴责他的慷慨之举，是很可耻的。”

科恩没有被吓倒。该网络刚刚开设了第10家诊所，还计划2020年之前增至25家。赫尔表示，科恩认为该网络比较成功，而且正考虑提升资助金额，超过之前承诺的2.75亿美元。（财富中文网）

译者：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.