When Alex Azar took over as Health and Human Services secretary, he was advised not to meet one-on-one with Seema Verma, one of his most important deputies. HHS staff said Verma was difficult to work with and quick to level accusations of sex discrimination — exactly where Azar finds himself now.

The big picture: Verma's claims that she's being discriminated against because of her gender extend throughout her tenure in the Trump administration, but her own behavior makes it difficult to tell whether the problem is her mismanagement or a male-dominated culture that makes it hard for a woman to hold her rightful sway, according to interviews with more than a dozen sources who know the situation well.

Verma has claimed she’s been treated poorly because she’s a woman under Azar’s leadership. The accusations came to a head over the summer, when she raised the possibility of a discrimination lawsuit.

Sources familiar with the controversies say Verma’s complaints focused on generalities — like HHS being a "boys' club" — rather than on specific slights or people. But some of those sources say she had a point.

Some sources recounted Verma being cut off, interrupted or dismissed in meetings.

“I won't go so far as to say it's out of sexism, but I do think some of the allegations and things she's being accused of personally are rising to attention because she is a woman,” one former CMS employee said. “They just made it really difficult for her to operate."

The other side: Azar’s allies, and other sources close to the situation, say Verma has undoubtedly been treated differently, but not because she’s a woman — rather, because she is miserable to work with.

Multiple sources brought up her habit of bypassing the secretary and going directly to the White House, specifically Vice President Mike Pence, with whom she has a close professional relationship.

Verma herself has been accused of creating a hostile working environment within CMS, and sources said her sharp elbows are what prompted more senior officials to mistrust her. Some said they've seen her make subordinates cry.

Verma "has a pattern of making accusations in an attempt to manipulate people and situations to get her way," said a source familiar.

The intrigue: All of this has happened twice. Verma also clashed with former HHS Secretary Tom Price, with allegations — on both sides — that mirrored the feud between her and Azar.

Verma told Price he was "creating a hostile work environment," according to a memo detailing the exit interview of Verma's former chief of staff, Brian Colas.

HHS staff warned Azar’s, during the leadership transition, that the relationship would be difficult and advised Azar not to meet with Verma one-on-one, to guard against later accusations and to make sure that directives were followed through on. It’s not clear whether Azar has followed that advice.

"It seems like the minute she gets called to the carpet on stuff, she starts attacking folks, and it goes beyond cabinet officials like Price and Azar," a source close to the administration said.

Both Price and Azar dealt with Verma similarly — by creating long paper trails to guard against accusations of wrongdoing and, in some cases, point fingers back at CMS.

Under Price, the HHS general counsel’s office, led at the time by Heather Flick, conducted exit interviews for CMS employees when they left.

Azar brought Flick back in, after she had left HHS, to conduct a new report on Verma’s accusations against him. Flick found the claims to be unsubstantiated after Verma declined to participate.

"Seema had an immediate negative reaction to her, because she was on HHS payroll," a source familiar with Verma's thinking said.

Sources differed on whether Flick’s interviews were an effort to get to the bottom of any issues, to ask leading questions that would establish a defense for HHS, or some combination of the two. And her reappearance at the agency this year made some sources question whether the discrimination investigation was sincere.

What they're saying: “These ridiculous accusations are an attempt to distract from the Administration’s policy successes. The Secretary and the Administrator are focused on executing the President’s bold healthcare agenda," HHS and CMS spokespeople said in a joint statement.

The bottom line: These allegations, with their mix of serious misconduct and petty grievance, make it hard to envision a real working relationship ever materializing between Azar and Verma. And as they spill into public view, they're a warning to future officials, as well.