President Donald Trump's Mar-a-Lago resort in Palm Beach, Fla., is seen in an undated photo. (Charles Trainor Jr., Miami Herald/TNS)

WASHINGTON — Three members of President Donald Trump’s private Mar-a-Lago resort acted as advisers and organizers at the Department of Veterans Affairs from 2016 to 2018, the Government Accountability Office determined after an investigation into the private citizens’ involvement in the federal agency.

The Mar-a-Lago members were involved in hundreds of email exchanges with VA officials, frequent phone calls and at least five in-person meetings. Three top VA officials — none of whom still work at the department — communicated with the men over private email accounts, records of which were unavailable to the Government Accountability Office during its investigation.

“The three private citizens interacted with VA and other federal officials frequently — at times daily, according to former VA officials — through email and telephone,” the GAO wrote.

Questions arose in 2018 about the influence that three members of Trump’s private club in Palm Beach, Fla., exerted over the VA, despite none of the men having served in the U.S. military or government. Some lawmakers and veterans’ advocates worried that Marvel Entertainment Chairman Ike Perlmutter, lawyer Marc Sherman and Bruce Moskowitz, a Palm Beach doctor, used their proximity to the president to steer VA officials on policies affecting millions of Americans.

At the request of Sens. Brian Schatz, D-Hawaii, and Elizabeth Warren, D-Mass., the Government Accountability Office initiated an investigation in spring 2019 into the relationship the three men had with VA officials. The results, released Wednesday, show the men were involved in at least five VA initiatives, from personnel decisions at department headquarters to a multibillion-dollar contract with Cerner Corp. to overhaul the agency’s electronic health record system.

“This new report confirms that three of Trump's friends, who have no experience in government let alone with veterans matters, were secretly shaping the VA's policies without any transparency or oversight,” Schatz said in response to the report. “Being a member of the president's club does not qualify you to influence decisions that affect the millions who served in uniform."

The GAO reviewed 223 email exchanges between the men and VA officials from 2016 through 2018. The three men made recommendations to the VA in 28 of those emails. In 70 others, they provided information to VA officials about different initiatives, including their thoughts on how the VA should handle its community care program. At the time, the VA was negotiating a major change to its process for sending veterans to private-sector doctors.

“The three private citizens acted as organizers by scheduling meetings with VA officials and helping to plan events,” the report reads. “At times, the emails show they acted as advisers by making recommendations regarding, for example, the Cerner contract negotiation … and potential candidates for senior-level VA positions.”

It was uncertain Wednesday what repercussions — if any — would stem from the report. A draft of the report was sent to the VA several weeks ago, but the department declined to provide written comment, the GAO said.

VA Press Secretary Christina Noel addressed the report Wednesday. In a statement, she claimed the report "vindicates the department and completely undermines the sensational way many media outlets covered this story."

A federal district court already has ruled that the three private citizens did not break the Federal Advisory Committee Act, an open government law that requires transparency of outside advisory groups.The court held that the VA did not use the men as an advisory committee and dismissed a complaint from VoteVets, a liberal advocacy group. VoteVets has appealed the decision.

Democracy Forward, an activist organization that often challenges Trump’s actions, also filed a complaint in U.S. district court. The suit alleges that former VA Secretary David Shulkin used a private, unofficial email account to communicate with the Mar-a-Lago members.

The GAO reported Wednesday that three officials — Shulkin, former Chief of Staff Peter O’Rourke and former Acting Undersecretary for Health Poonam Alaigh — communicated with the men from private email accounts. The former VA officials directed the Mar-a-Lago members to use those email addresses.

“We cannot quantify how often exchanges occurred on non-governmental email accounts as we did not obtain those emails,” the GAO wrote.

The GAO was also unable to obtain text messages and personal phone call logs.

Perlmutter, Sherman and Moskowitz told the GAO that they did not have a formal role at the department and had no decision-making authority.

“According to a written statement from the three individuals, they provided advice and introductions when asked by VA officials and helped to connect VA to other private citizens who were health care experts to help VA improve services and health care provided to veterans,” the report reads.

Former VA officials, who were not named in the GAO’s report, told the watchdog agency otherwise. The officials told the GAO that Perlmutter, Sherman and Moskowitz had “power and influence” at the VA, “in part because of the connection of one of the three private citizens to the president,” the report says.

One former official told the GAO that the three men created a “shadow reporting structure” that created confusion for VA employees who recognized their influence. Shulkin was forced to get the buy-in of Perlmutter, Sherman and Moskowitz on certain decisions, including the Cerner contract, another VA official told the GAO.

The influence of the three men might have led to delays with the Cerner contract, the GAO found. The department paused negotiations in part to address concerns from Perlmutter, Sherman and Moskowitz.

The men also meddled in personnel decisions at VA headquarters, the GAO reported. They suggested candidates forchief information officer and undersecretary for health positions. The VA tried to hire one of their recommendations for chief information officer but failed.

Warren said the report showed that “corruption ran rampant at the VA.”

“Three unqualified, unaccountable cronies used their personal relationship with the president and membership at his country club as leverage to exert personal influence over health care, technology, personnel and other key decisions,” Warren said.