Vice President J.D. Vance and Health and Human Services Secretary Robert F. Kennedy Jr. have formally referred more than 225 hospitals and clinics to the U.S. Department of Justice for alleged fraudulent billing practices related to transgender-related care for minors. The referrals follow the release of a 64-page HHS report titled “Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of ‘Gender Medicine.’”
The referrals mark the latest escalation in a federal crackdown on pediatric gender-affirming care, with Vance and Kennedy citing concerns over misleading billing codes and potential financial incentives for providers. The HHS report alleges that hospitals may have fraudulently billed Medicaid and private insurers for procedures such as puberty blockers, cross-sex hormone therapy, and gender surgeries in minors by using incorrect or misleading diagnostic codes.
HHS estimates potential fraud losses at nearly $50 million, based on claims filed between 2015 and 2025. The report specifically highlights the use of codes like “endocrine disorder, unspecified” and “precocious puberty” to secure insurance coverage for treatments that critics argue lack sufficient medical evidence for minors.
Federal Response and Allegations
Vice President Vance, who heads the White House Anti-Fraud Task Force, stated in a social media post that the report contains “deeply disturbing allegations” of hospitals subjecting children to “horrific, experimental treatments” under the guise of gender-affirming care. He added that providers may have profited tens of thousands of dollars per child by exploiting billing loopholes.
Kennedy echoed these concerns in an HHS press release, stating that the findings raise “serious questions about what families were told, what insurers were told, and how these procedures were billed.” The HHS report was released alongside a short documentary featuring testimonials from young adults who said they regretted receiving gender-affirming care, which the administration framed as evidence of misleading practices.
The Centers for Medicare and Medicaid Services (CMS) also announced cuts to Medicaid funding for hospitals offering gender-affirming care to minors, effective two days before the report’s release. CMS cited concerns over patient safety and lack of evidence for such treatments in children.
Medical Community Pushback and Policy Debate
The American Medical Association (AMA) and American Academy of Pediatrics (AAP) have strongly opposed the federal actions, arguing that the CMS restrictions are baseless and could harm patients. In a statement, AAP President Susan J. Kressly warned that “allowing the government to determine which patient groups deserve care sets a dangerous precedent.”
Critics of the HHS report argue that the focus on billing practices distracts from broader debates about access to gender-affirming care. They contend that medical societies, including the AMA and AAP, support these treatments based on peer-reviewed research and clinical guidelines. The report, however, does not address these endorsements, instead framing the issue as a financial and ethical failure of providers.
The HHS report also notes that more than 225 hospitals and health systems established pediatric gender clinics during the decade-long period studied. While the document alleges systematic misuse of billing codes, it does not provide individual hospital-level evidence of fraud, instead citing patterns of questionable coding practices.
Next Steps and Legal Implications
The DOJ and HHS Office of Inspector General have been tasked with investigating the referred hospitals for potential violations of federal law, including fraud, false claims, and abuse of billing systems. The outcome of these investigations could lead to civil penalties, criminal charges, or loss of federal funding for non-compliant providers.
The referrals come amid a growing patchwork of state-level restrictions on gender-affirming care for minors, with Texas and other states passing laws banning such treatments. The federal actions signal a coordinated effort to challenge the medical and financial underpinnings of pediatric gender clinics nationwide.