WASHINGTON, D.C. — The Department of Health and Human Services last week referred hospitals and clinics involved in pediatric gender-transition care for possible federal investigation after a commissioned report identified insurance-billing patterns that the agency says warrant scrutiny for potential fraud or improper coding.
The referrals were made to the Department of Justice and the HHS Office of Inspector General by Vice President JD Vance, in his role as chairman of the White House Task Force to Eliminate Fraud, and HHS Secretary Robert F. Kennedy Jr., according to the department.
The action follows publication of an HHS report titled Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine.” The report examines insurance claims, medical coding, financial incentives and treatment of minors receiving gender-related medical care.
HHS said the report draws on Centers for Medicare & Medicaid Services guidance, Justice Department investigations, peer-reviewed literature, hospital records, whistleblower testimony, insurance-claims data and interviews with patients and parents.
The department also released a short documentary alongside the report.
According to HHS, the analysis identified more than 225 hospitals and health systems that established pediatric gender programs nationwide.
The report examined nationwide insurance claims from 2015 through 2025 and identified approximately $50 million in claims for puberty blockers billed under diagnostic code E34.9, or “Endocrine Disorder, Unspecified.”
It also identified nearly $11 million in claims involving patients ages 13 to 17 that were billed using E30.1, a diagnostic code for precocious puberty, according to HHS.
The report does not, based on information provided in the department’s release, establish that those claims were fraudulent. HHS said the coding patterns warrant additional review to determine whether billing practices complied with applicable federal and state requirements.
“This report identifies troubling billing practices that demand scrutiny,” Kennedy stated. “HHS will follow the evidence, protect taxpayers, and hold accountable anyone who broke the law.”
The referrals represent requests for further investigation rather than findings of legal liability.
HHS said the report recommends federal and state authorities review coding and billing practices, strengthen oversight of claims submitted to government health programs and investigate suspicious activity when warranted.
CMS Administrator Mehmet Oz said the agency is focused on determining whether billing accurately reflected the care that was delivered.
“When billing practices obscure what care was actually provided, especially when children are involved, we have an obligation to follow the facts,” Oz stated.
The administration has separately moved to restrict federal financing for certain gender-transition treatments for minors through Medicaid and the Children’s Health Insurance Program, making scrutiny of related billing practices part of a broader federal policy shift on pediatric gender care.
HHS characterized the treatments examined in its report as “sex-rejecting procedures,” including puberty blockers, hormones and surgeries. That terminology reflects the administration’s framing of the issue.
The report calls for continued examination of insurance coding, program-integrity controls and clinical policies involving pediatric gender medicine. Any determination that hospitals, clinics or individual providers violated federal law would require further investigation or adjudication by the appropriate authorities.
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