Hundreds of healthcare organizations, including health systems, pediatric hospitals, physician groups, pharmacy benefits managers, specialty pharmacies and Planned Parenthood affiliates, have been referred to federal law enforcement for investigation of insurance claims they filed related to gender-affirming care services for minors, the Department of Health and Human Services announced Thursday.
The sweeping list of referrals (PDF) stems from a report commissioned by the department that broadly “exposes” coding practices that its authors said allowed providers to financially benefit from gender-affirming care, which HHS and the broader Trump administration assert are medically dangerous and have worked to limit.
That position is at odds with most leading medical associations, including the American Academy of Pediatrics, the American Medical Association and the American Psychological Association, which, along with provider organizations, the administration and the authors of Thursday’s commissioned report have broadly accused of bias and ideological capture.
“Doctors and hospitals must put children’s health ahead of ideology and financial gain,” HHS Secretary Robert F. Kennedy Jr. said in a statement. “This report identifies troubling billing practices that demand scrutiny. HHS will follow the evidence, protect taxpayers, and hold accountable anyone who broke the law or violated the trust of patients and families.”
Specifically, the new report highlights a set of insurance claims “that exhibit potentially anomalous billing patterns, which justifies further scrutiny,” Kennedy wrote in his referrals to the HHS Office of Inspector General (HHS OIG). Vice President J.D. Vance penned a similar referral to the DOJ, according to an HHS release.
Among these are about $50 million in claims from 2015 through 2025 for minors’ puberty blockers that billed under the diagnostic code for unspecified Endocrine Disorder (E34.9), but on the same claim No Gender Diagnosis (F64x) and No Precocious Puberty (E301). Nearly 100 unique National Provider Identifiers (NPIs) were referred for such claims, a cohort that includes well-known organizations such as Boston Children’s Hospital, Children’s Hospital Los Angeles, Rady Children’s Hospital, NYU Langone Hospitals, Caremark and Walgreens.
A group of about 120 unique NPIs, which include those same names plus others like Providence and Orlando Health’s medical group, were also referred over nearly $11 million in claims for puberty blockers and Precocious Puberty Diagnosis (E301) on the same claim.
Another cohort of 10 organizations was referred over claims filed for care that coincided with state prohibitions on gender-affirming care for minors. Additionally, nine Planned Parenthood affiliates were referred because a prescriber billed nearly all of their claims to that affiliate.
“When billing practices obscure what care was actually provided, especially when children are involved, we have an obligation to follow the facts,” Centers for Medicare and Medicaid Services Administrator Mehmet Oz, M.D., said in a statement. “We will protect the integrity of our programs, demand accountability, and make sure the American people are not footing the bill for sex rejecting procedures that inflict potentially irreversible harm on young patients.”
The commissioned report (PDF) was authored by policy, medical and media contributors who, according to the biographies included in the report, are affiliated with organizations critical of gender-affirming care or have themselves previously advocated against the services. The authors described their list of identified claims as a non-exhaustive starting point for heightened scrutiny and recommended additional oversight.
The release follows other HHS investigations—such as a literature review from last year that was scrutinized by LGBTQ+ advocacy groups—that have concluded that non-behavioral pediatric gender-affirming care treatments carry limited or unclear benefit but substantial risk to patients.
These works have served as the scaffolding beneath regulatory, policy and law enforcement actions the administration has taken to end such services across the country. Just this week, for instance, CMS finalized a rule pulling funds for gender-affirming care for minors from Medicaid and the Children’s Health Insurance Program, which will take effect in the fall. A concurrent proposal to bar hospitals that offer the services from Medicare and Medicaid was stalled following a swift legal challenge, though officials say they are still planning to release it.