The Middlemen
A note from the publisher. My father is not dead. He is suffering horribly in a veterans nursing home in Daytona Beach, and he has not received the care the VA promised him — for things they accepted responsibility for and did not deliver. Somewhere between the promise and my father, middlemen took the money and ran without delivering the services.
These pages are the middlemen — every one we can document, profiled from the government's own records: their contracts, their dollars, their watchdog files. I could not stop what was done to him. I can make sure it was done in public, with their names on it. Fair is fair.
And to Secretary Doug Collins, who has never answered a single letter about any of it: go fuck yourself.
— Thomas A. Bowman Jr.
Between a veteran and his care stands a line of companies. The VA does not, for the most part, deliver community care, judge disability exams, run the dental network, broker the rides, or keep its own new medical record — it pays companies to stand in those places, and the companies take their percentage for standing there. This section profiles every one of them we can document: what it sells, the contract and the dollars — every figure sourced on the page — its record with the government's own watchdogs, and, only where the case record ties it, its place in one family's chain.
The money spine
- Community care is the VA’s fastest-growing river of money: $37.1 billion in FY2024, against a $48.0 billion FY2026 request (VA budget figures, via The Independent Budget) — up from $9 billion in 2019.
- The next generation is already awarded: on August 31, 2026, the VA awarded CCN Next Gen Medical to four administrators — Optum, TriWest, Humana, Wellpoint — under a $1 trillion shared ceiling with ordering from 2027 to 2036 (federal award records, as analyzed by GovConic, Oct 5, 2026). A ceiling is not spending; it is the size of the door.
- The middlemen kept $910.7 million of the dental money alone: the VA OIG (Feb 20, 2025) estimated that from FY2020 to May 2024 the VA paid the two community-care administrators $910.7 million more for dental services than the administrators paid the dentists — because the contracts let them keep the difference. Optum’s share: about $783.4 million. TriWest’s: about $127.3 million.
- The exam is a $13.2 billion vehicle: the disability-exam contracts’ ceiling, blown through once already after the PACT Act surge — over 3 million contracted exams in FY2024, over $5 billion in that year alone (GAO), performed by vendors the OIG has found below the contracts’ own accuracy standard since 2017.
Tier 1 — the Bowman chain
The companies in one family’s record, profiled deepest:
- Acentra Health — the Medicare appeals body (BFCC-QIO) whose appeals door bounced this family’s expedited rebuttal; also a VA claims-system contractor.
- Optum Serve / Optum — Florida’s community-care administrator (Region 3); exams, dental, and the $783.4M dental share.
- TriWest Healthcare Alliance — the western half of the machine (Regions 4–5); $127.3M of the dental spread.
- Conviva Care Centers — Dad’s primary care network. It produced zero records to this family.
- AdventHealth New Smyrna Beach — the December 2025 surgery hospital. The operative note does not exist in the record; the HIPAA refusal does.
- Borland Groover — the GI practice in the record. Its complete chart is still not held.
- Hoveround Corporation — the approved power chair, addressed to his dead wife, never delivered.
- Delta Dental — the VA’s dental route: insurance the veteran pays for himself, and the CCN dental network.
- Modivcare — the national ride-broker layer — printed honestly: no VA contract found.
- Oracle Health — the record that replaced the record: $10B sold, $49.8B independently estimated.
- UF Health Shands — observation status, in Shands’ own paper.
Tier 2 — the national census
- Veterans Evaluation Services (VES) · QTC Medical Services · Loyal Source — the exam mills: $3.7B, $5.1B and $2.46B obligated respectively, under an accuracy finding that has stood since 2017.
- Humana Government Business · Wellpoint Federal — the new entrants: CCN Next Gen seats won in August 2026.
- Health Net Federal Services — the legacy middleman: $101.4M in duplicate and erroneous payments in one audited year.
- DaVita · Fresenius Medical Care — the dialysis duopoly (~74% of the U.S. market).
- Labcorp · Quest Diagnostics — the labs, region by region, schedule ceiling by schedule ceiling.
- Maxim Healthcare — home care for veterans; a $150M fraud settlement in its past.
- Aveanna Healthcare · LHC Group · Amedisys — home health & hospice at national scale, two of them now inside UnitedHealth.
- Express Scripts · OptumRx — the pharmacy middlemen — printed with the correction that the VA’s pharmacy is in-house, and their federal money is TRICARE’s.
- Magellan Federal · Sedgwick · Conduent — the adjacent claims machines, labeled for what they actually administer.
- General Dynamics IT · Accenture Federal Services · Peraton — the IT layer underneath the record.
How a profile is built
Every dollar carries its source on the page — VA OIG, GAO, FPDS-derived records, SEC filings, DOJ — and every oversight item links to the document itself. Where a company’s record is a parent company’s, the page says so. Where no contract or no adverse finding could be sourced, the page prints exactly that. And where a company answered its auditors, the answer is printed too. The documents are the indictment; nothing here needs inventing.
The census continues: the build queue of additional vendors found — name, category, and contract evidence — is kept in the case file and worked by the daily engine until every hand in the chain has a page.