The secret campaign to silence critics of a hospital real estate empire

By the spring of 2022, Ed Aldag was fed up. The 61-year-old CEO of a multibillion-dollar real estate company called Medical Properties Trust, Aldag is a high-society fixture in the company’s hometown of Birmingham, Alabama, where MPT has donated millions to local nonprofits and where he’s regularly listed as one of the city’s most influential businessmen. But for years, Aldag had watched as MPT faced tough questions from the federal government, investors, and, most recently, a series of articles in the Wall Street Journal. 

MPT makes money by acting as a landlord: It buys hospitals and then rents the facilities back to providers. Over the previous year, the Journal had published several stories that focused on the company’s finances, including reporting that dug into MPT’s biggest tenant—Steward Health Care, then one of the largest for-profit hospital operators in the nation—and the unusually close financial relationship between the two companies.

The Journal’s pieces raised concerns about whether Steward was struggling—and whether MPT was engaging in secret transactions to keep it afloat. Mother Jones and others would later report how Steward’s financial mismanagement harmed hundreds of people: We found 83 deaths across its 39 hospitals, hundreds of malpractice lawsuits, and more than 700 patient care problems documented in federal hospital inspections. The Journal, meanwhile, was the first to notice this mismanagement at work, revealing that Steward hospitals owed nearly $1 billion to medical supply companies and other vendors.

That reporting was the beginning of years of intense scrutiny of MPT in the world of finance that hurt the company’s stock price and eventually led, earlier this month, to a trio of Democratic US senators proposing the “Stop Medical Profiteering and Theft (MPT) Act” to impose limits on the company’s business. But it was also the apparent start of an aggressive, previously unreported campaign by Steward, MPT, and other still-unknown actors to silence their critics. Internal documents obtained by the Organized Crime and Corruption Reporting Project (OCCRP) and shared with Mother Jones show that MPT amassed an army of crisis management professionals to protect its reputation, eventually working alongside three different crisis public relations firms, five law firms, and two private intelligence firms. The documents, along with information from sources close to this effort, show a major effort to control the narrative: In one tense email exchange in March 2022, Aldag wrote to a PR firm, “We cannot let a deranged pretend journalist tell a false story of MPT.” 

As part of a social media push that used anonymous accounts to discredit and intimidate the growing chorus of journalists, investment analysts, and short sellers who questioned the company, an intelligence firm baited MPT’s detractors online. And while the Boston Globe and OCCRP reported last year that Steward paid the British firm Audere International to surveil one particularly provocative MPT critic, new documents show a much broader tracking campaign, funded in part by Steward and other shadowy actors but focused on MPT, targeting a half dozen of the company’s skeptics.

“They were always looking for something explosive that would make things go away,” a source close to Audere wrote in messages reviewed by Mother Jones that were confirmed with the source directly. “Although Steward was the customer, it was clear that MPT was what Audere was protecting.” 

An MPT spokesperson did not respond to a detailed list of questions but made clear in an emailed statement that the company disagrees with the many critics questioning its business practices. The company, the spokesperson said, “has unfailingly disclosed each of its transactions as and when required under applicable securities laws.”

The spokesperson also said that as criticism of MPT has mounted, its executives and their families have been harassed, including receiving death threats: “As any responsible company in that position would do, we have periodically engaged advisors to help navigate this situation.” The spokesperson added: “It is critical to note that MPT has never directly or indirectly engaged with detractors on social media, nor have we paid any third-party to do so.” 

The company’s damage control started in earnest with the lead reporter behind the Journal’s stories, Brian Spegele. His reporting on MPT began in 2021, when a number of its tenant hospitals across the country—a Steward hospital in Pennsylvania, and ones owned by other for-profit operators in Wyoming and Rhode Island—all seemed to be running into financial issues. While these facilities struggled, MPT was hitting its highest stock price ever.  

Spegele emailed MPT with questions about how it was running its business—and how it might be affecting hospitals. He’d heard from insiders that MPT was overpaying for hospitals because higher sale values meant they could charge higher rents. Did the company want to comment? Why had one of their hospitals in Ohio shut down not long after it started renting from MPT? Did the company really have three corporate jets? 

In dozens of leaked emails, Aldag strategized with other leaders over how to respond. They brought in the crisis PR firm Joele Frank to help, as well as a law firm that specializes in filing defamation cases against journalists, Clare Locke. They asked their PR firm to speak with Spegele and suss out the angle of his upcoming article and questioned whether the Journal was working to short their stock. Was the paper hinting to investors that MPT was going to fail?    

In December 2021, Clare Locke sent a letter to the Journal’s legal team and top editors, threatening to sue the paper before Spegele had even published his next story and demanding that he reveal his sources. The following month, MPT’s stock hit a new high: about $24 per share. Not long after, the paper’s lawyer sent an email to Clare Locke, noting that Spegele had experienced “some security concerns,” and he wanted to discuss them on the phone. (Spegele declined to comment; a Wall Street Journal spokesperson did not answer specific questions but noted, “The safety and security of our reporters is of paramount importance. While we won’t discuss the details of the protective measures we take, we stand by the Journal’s in-depth and consequential reporting on Medical Properties Trust.” Clare Locke and Joele Frank also did not respond to questions.) 

The Journal published Spegele’s piece in February 2022. It claimed that MPT was quietly infusing hundreds of millions into Steward through complex loans and other means, enabling its hospitals to continue to pay rent. This meant that MPT’s largest tenant was actually struggling, which boded poorly for MPT, as well. Yet the article also pointed out executives’ excessive spending on things like Aldag’s multimillion-dollar salary and the regular use of the company’s private jets. Investors started emailing and calling MPT, and its stock price began to slide. 

Spegele soon started working on another story, about an MPT-owned hospital in California. His continued requests for comment angered Aldag. 

“I’m tired of this guy,” Aldag wrote, adding that the former employees Spegele had cited anonymously were “absolutely fake.” Then he called his team to action: “We already know what he is going to say and I refuse to let him tell the story…We need to devise a plan to be proactive in our storytelling outside of the WSJ.” He told his PR advisers that if this wasn’t a project they could take on, he imagined they could find other companies to help. 

“Ladies,” he wrote, “it’s time we go on the offensive.”

Investment analyst Rob Simone thought there was something to the Journal’s stories. He worked at a research firm called Hedgeye, and soon he started digging into whatever public information he could find about MPT. 

He was struck by the fact that MPT seemed to be at the root of Steward’s financial issues—and its hospitals’ increasing problems paying their bills. According to our own analysis, by 2022, at least four health care companies that had lease agreements with MPT had gone bankrupt, shutting down hospitals or throwing them into uncertainty.

Simone told Hedgeye’s paid subscribers in April 2022 that MPT was sinking hospitals instead of helping them, by saddling their operations with leases they couldn’t afford. He claimed that beneath its veneer of success, Steward “appears to be insolvent” and that its dwindling finances likely meant future trouble for MPT, which he suggested was quietly infusing money into Steward to help it pay rent. And he wondered about the compensation that MPT’s board of directors (which includes Aldag and the company’s CFO) had green-lit for executives, while Steward and some of their other tenants were financially struggling. He recommended shorting the stock.

“I just started doing work on this and became fascinated and thought it was a real problem—and that problem kept getting worse, and so I kept writing about it,” Simone told us when we spoke last year. “It never, never, ever improved.”

MPT leadership pilloried Simone’s research on the company’s next earnings call. But Simone’s reports about MPT continued to gain traction on Twitter and investing websites, especially as the company’s stock price started to dip, from around $20 to $15 in the summer of 2022. 

And Simone wasn’t alone. A writer who called himself @BigRiverCapita1 was making similar claims on social media and Wall Street blogs. The account was anonymous but clearly well versed in finance, pointing out past bankruptcies of MPT’s tenants and questioning whether these hospitals were struggling, shutting down, or cutting back patient care due to their pricey leases with MPT. 

Around then is when Audere, the British private intelligence firm, got involved. According to OCCRP and the Boston Globe, Steward had already been paying to surveil its critics for a few years—eventually spending more than $7 million on these operations. But as Big River’s posts and Simone’s research spread, and more investors began to short MPT and drag down its stock price, Audere’s work increasingly focused on those critical of the publicly traded landlord, even as its tenant Steward remained Audere’s client, according to leaked documents and sources close to Audere. (An Audere spokesperson told Mother Jones that the company cannot answer questions about its confidential work, but that Audere “takes its legal and regulatory compliance obligations seriously and acts in accordance with the same.”)

In June 2022, Audere hired a contractor to start looking into these critics, leaked emails show. They named the operation “Project Morden.” They told the contractor they had two main goals: Dig into why Rob Simone was writing about MPW (they referred to MPT by its stock ticker symbol), and identify the person behind @BigRiverCapita1:

A strategy memo noted that “multiple financial professionals believe that RS [Rob Simone] does not have the capacity to drive MPW downward.” Still, the firm demanded an aggressive approach to Big River and Simone, whom they deemed Target 1 and Target 2.

“Uncover the subjects (sic) vulnerabilities and pressure points,” the memo urged, suggesting the contractor unearth details about “career, integrity, personal life and identify any potential misconduct.” 

And that, Simone said, is when the trouble started. 

Anonymous Twitter accounts started to follow and harass him, asking if he had security and even tweeting that “his life [was] in danger.” Simone’s company, Hedgeye, grew concerned about this safety and provided him with enhanced security, but neither they nor Simone ever figured out who was behind the accounts. One tweet even warned that if he didn’t stop reporting and tweeting about MPT, “he could end up like Daphne,” an allusion to the murder of the Maltese journalist Daphne Caruana Galizia, who was killed after reporting on a Steward hospital deal in Malta in 2017. 

MPT’s leaders also began to meticulously track their detractors. By October 2022, they were keeping tabs on all the skeptics dialing in to their public earnings calls and even discussed not taking their questions: “Please make us a list of all the bad actors that listened in,” Aldag wrote to top executives in an email. They sent back a lengthy list that included nearly 20 professional financial analysts, including Simone.

The following month, MPT received Audere’s intelligence reports over email. And soon, Audere further ramped up its campaign against Simone, even hiring a contractor to create a fake blog written from the perspective of a woman trying to hold investment analysts to account. But its true goal was to criticize just one player: Hedgeye. It was called “Hedge Spy.” (After Mother Jones and Reveal mentioned this contractor’s work in previous reporting, the blog was taken down from the internet.)

Initially the blog was populated with stories that cast doubt on a variety of firms, as the contract writer explained to Audere in emails reviewed by Mother Jones. “The more general content will disguise the blog’s objective,” wrote the contractor.

The contractor also launched a Reddit account, Loud-Peanut-7716, whose goal was “to actively engage in discussions and facilitate the conversations concerning Hedgeye.” In an email to Audere, the contractor listed some of the Reddit posts trying to discredit Simone’s firm:

“Can you recommend any research platforms? I tried Hedgeye but I don’t trust them after their recent dirty tricks stalking and intimidating their competitors”

“They don’t care about making us rich, they want to make THEMSELVES rich! DO YOUR OWN RESEARCH!”

At the start of 2023, a new critic took on MPT, publishing a series of reports with cheeky titles and provocative tweets that alleged MPT was committing a brazen financial fraud.

That voice was a British investor named Fraser Perring. Perring runs a short-selling firm called Viceroy Research that makes big financial bets on companies it thinks will fail, digging deep into their financials to see if they might be hiding something. He has tens of thousands of followers on social media, where he often posts his findings and claims of corporate wrongdoing.

In January of that year, Viceroy published the first of what would be several reports on MPT. Titled “Medical Properties (dis)Trust,” the report arrived at many of the same conclusions that had been swirling around Wall Street: Steward was going belly up, and MPT seemed to be secretly funneling it money to stave off bankruptcy. And perhaps more clearly than anyone before, Viceroy accused MPT of “round-tripping”: Not only was it loaning money to help Steward pay rent, but it was then recording this rent as new earnings and not disclosing it, all to maintain the illusion that it was a healthy landlord.

Viceroy’s report sent MPT executives into a tizzy. Leaked documents show the company was scrutinizing Perring’s tweets alleging round-tripping, with executives furiously sharing them with one another and one of their PR firms compiling them all.

Management soon would help fuel a conspiracy theory that was already growing at MPT: that their critics—from Simone to the Wall Street Journal—were working together to short their stock and bring them down.

Around that time, social media trolling of Simone and Perring ramped up. On top of that, reporting from the Boston Globe and OCCRP shows that a security firm contracted by Audere videotaped Perring at his home and watched him around his neighborhood—even following him and his daughter on their way back from school. When MPT sued Viceroy the following month for defamation, it denied all of Perring’s findings, writing that they were “malicious fiction” and had “caused serious harm to MPT.” But during litigation, according to court documents, Viceroy’s lawyers said an impostor had called Perring’s bank in the weeks leading up to MPT’s suit and pretended to be him. It’s unclear who was behind the impostor, who was able to gain access to Perring’s financial transactions; soon those details were included in a report sent to Audere. No money was stolen, but in reports to Audere the impersonator tried to figure out what Perring was spending his money on. (MPT, which agreed to settle the defamation case last December, said in a statement that it hired Audere in late 2022 for work unrelated to Perring.) 

A few months later, when JP Morgan recommended that investors view the company’s stock with caution, emails show that MPT’s top executives circulated a lengthy list of analysts they believed were somehow connected to each other. They named five different investment funds and investors, and the many possible ways they were “connected”—to each other, to a Journal reporter, to Hedgeye, to Viceroy, even to liberal megadonor George Soros. And they wondered if anyone in their “army of advisors” had an in with regulators. Included on that email chain was exactly that kind of connection, someone who used to run the Consumer Financial Protection Bureau: Mick Mulvaney.

Mulvaney, who also had been President Donald Trump’s acting chief of staff, was helping to run a consulting firm called Actum. Leaked emails show that MPT brought Actum on to help it “combat” what they saw as people conspiring to target the company. To counter their criticisms, Actum drafted a white paper praising MPT, calling it a company “investing in the future of health care and communities.” (Actum did not respond to questions from Mother Jones.)

Reputation management is common among publicly traded companies, notes Jo-Ellen Pozner, a professor of business at Santa Clara University who studies corporate conduct and ethics. But the scale and expense of the effort to manage MPT’s PR crises is “unequivocally not normal,” she says. 

“The fact that these folks were so willing to waste company resources—spend significant amounts of money that could have been diverted to more productive uses—to investigate journalists, to investigate investment analysts, it suggests to me that they are spying, and think that everybody else is doing the same,” Pozner said. 

While MPT focused on its value and reputation, patient care issues at its Steward hospitals began to reach crisis levels. Under the weight of years of high rents to MPT, these facilities had failed to pay on-call doctors, nurse staffing agencies, repairmen, and suppliers of everything from blood to hospital beds. Eventually, some Steward hospitals couldn’t afford to keep paying MPT rent and closed. 

These troubles further drove MPT’s stock price down. In October 2023, when it dipped below $5, Aldag recorded a message to shareholders, telling them he remained confident in “MPT’s proven business model” for investing in and improving hospitals. 

At one of them, St. Elizabeth’s in Massachusetts, a crisis had begun to unfold. The hospital owed more than $500,000 to a company that made devices used to stem internal bleeding called embolism coils; the supplier recently had come to repossess the coils. 

Two weeks after Aldag posted the video reassuring shareholders, a first-time mom named Sungida Rashid delivered a baby girl at St. Elizabeth’s. Hours later, Rashid began to bleed severely, doctors discovered they didn’t have the embolism coil needed to treat her, and she died. Her family’s tragedy would set in motion articles and hearings and subpoenas trying to understand the financial dealings of MPT and Steward. It had taken years—and a mother’s life—for the story to finally come to light. 

Additional reporting by Khadija Sharife.