HHS Refers Over 200 Hospitals and Clinics to DOJ Over Pediatric Gender Care Billing Codes

HHS released a report Thursday titled "Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of 'Gender Medicine,'" accusing more than 225 hospitals and health systems of running pediatric gender programs funded in part through what the department calls anomalous insurance billing. Vice President JD Vance and HHS Secretary Robert F. Kennedy Jr. announced the findings alongside Assistant Secretary Adm. Brian Christine, according to HHS.gov and the Daily Signal.

The report examined nationwide insurance claims data from 2015 through 2025. It found roughly $50 million in claims for puberty blockers billed under E34.9, the code for an unspecified endocrine disorder, according to HHS's own release. It also found nearly $11 million in claims for patients ages 13 to 17 billed under E30.1, the code for precocious puberty. HHS says these patterns warrant further review.

Based on those findings, Kennedy referred the matter to the HHS Office of Inspector General, and Vance, in his role chairing the White House Task Force to Eliminate Fraud, referred it to the Department of Justice. Kennedy's letter to Inspector General T. March Bell, dated Aug. 12, asks OIG to "swiftly evaluate" the referral, according to the Straits Times.

The Straits Times reports Kennedy broke the flagged institutions into four categories. The first group billed puberty blockers for children ages 9 to 17 with an endocrine disorder code alongside a "no gender" or precocious puberty diagnosis on the same claim. The second group billed puberty blockers for 13-to-17-year-olds using a precocious puberty code. The third group billed cross-sex hormone prescriptions the same day as a primary gender dysphoria diagnosis, in states where the procedure was banned for minors at the time. The fourth category singles out Planned Parenthood affiliates over what HHS describes as a high volume of flagged claims.

Fierce Healthcare, citing the referral list itself, reports the sweep covers health systems, pediatric hospitals, physician groups, pharmacy benefit managers and specialty pharmacies, not just doctors' offices. The Straits Times names specific institutions caught up in the referral, including Boston Children's Hospital and Cigna's Accredo Health Group, a specialty pharmacy provider.

At the press conference, Christine did not mince words. He called the procedures "sex-rejecting, mutilating, transgender procedures" and took a direct shot at his predecessor, Biden-era Assistant Secretary for Health Rachel Levine, saying she pushed the practices without justification, according to the Daily Signal. Kennedy framed the issue around informed consent and taxpayer protection, stating that "doctors and hospitals must put children's health ahead of ideology and financial gain."

What's actually established here: HHS pulled real claims data spanning a decade and found specific dollar figures tied to specific diagnostic codes. That data exists and the coding pattern is documented in the report. What is not established is criminal intent. A referral to DOJ or OIG is not a charge, an indictment, or a finding of guilt. No hospital named in the report has been convicted of anything, and none has yet had a chance to respond in a legal proceeding.

There's also a real question the report raises. If puberty blockers or hormone treatments were billed under codes for conditions the patient didn't actually have, in order to get insurers to pay for a service they might otherwise deny or scrutinize, that's a legitimate billing integrity question regardless of anyone's views on the underlying treatments. Insurance fraud investigations built on mismatched diagnostic codes are a normal, unremarkable part of federal health enforcement.

At the same time, medical groups including the American Academy of Pediatrics, the American Medical Association and the American Psychological Association have for years defended these treatments as clinically appropriate care, and Fierce Healthcare notes the administration and the report's authors have accused those same associations of "bias and ideological capture." That's a real dispute between the administration and mainstream medical bodies, and it's one where both sides have a stake: the administration has built its health policy around restricting these treatments, and the medical associations have staked their clinical guidance on defending them. Neither side here is a disinterested referee.

The report lands alongside other administration moves. HHS finalized a rule on Aug. 11 restricting Medicaid funding for gender-affirming care for minors, according to the Straits Times, and the DOJ and Federal Trade Commission have separately opened probes into medical groups supporting transgender health services.

None of the referred hospitals, pharmacies, or Planned Parenthood affiliates has been charged. HHS OIG has not announced findings, and DOJ has not confirmed whether it will open formal investigations into any of the named institutions. Whether the billing patterns HHS flagged reflect deliberate fraud, defensive coding practices insurers required for reimbursement, or something else entirely is exactly what those referrals are now supposed to determine.