Vice President JD Vance has referred allegations of fraudulent gender-care billing to the Department of Justice for a federal criminal investigation.
The 64-page HHS report, titled “Wolves in White Coats,” documents what the agency calls irreparable “harm to America’s youth” inflicted by healthcare providers and hospital systems over roughly the last decade. The report alleges that providers lined their pockets by promoting costly procedures and treatments for gender-confused minors, with billing data showing nearly $120 million in gender-related medical treatments to minors since 2019. The findings have prompted the Trump administration to launch a criminal investigation into whether providers committed fraud or violated federal law.
“This Administration will not stand idly by while some in the medical community harm our children in search of profit,” Vance wrote on X Thursday afternoon, in a letter he penned to Attorney General Todd Blanche. “That is why today I am referring this matter to the Department of Justice to launch a federal criminal investigation. We will stop this fraud and restore trust in public health,” he vowed.
The report identifies Mount Sinai Medical Center in New York and Boston Children’s Hospital as among the highest billers, with $8.2 million and $6.5 million respectively in gender-related care between 2019 and 2023. Those figures encompassed more than 5,500 surgical procedures and 8,500 courses of hormone treatments or blockers. HHS notes these price tags exclude ancillary treatments like banking egg or sperm cells, voice therapy, and hair removal.
HHS points to “financial incentives” as one potential explanation for the explosion in gender-related care for minors. “Gender clinics changed that calculus by introducing a novel source of revenue: they promised a new stream of continuous revenue for pediatrics, endocrinology, and surgical specialties by taking physiologically healthy young people — who otherwise would not need to seek medical attention, and rendering them dependent for life on the medical system,” the report states.
The report accuses health care providers of willfully misusing diagnostic codes — diagnosing patients with endocrine disorder or precocious puberty — to get insurance to foot the bill or to protect a patient’s privacy. Citing claims data, HHS writes that annual healthcare spend for a child under 18 averaged around $3,000, far less than a lifetime of hormone treatments or a single operation. Hormone therapy costs between $545 per year for androgens and $735 for estrogen, with puberty blocker GnRH running $16,385 annually. “Lifetime totals for a patient starting as a minor can reach $25,000-$75,000 even without surgeries,” HHS writes, citing figures from transgender advocacy group Human Rights Campaign. “When surgeries are included, individual lifetime spending on surgical interventions can easily exceed $100,000 and approach $170,000.”
“In an era of razor-thin pediatric margins and pressure on hospital reimbursements, this new patient cohort—young, insured or Medicaid-eligible, and requiring perpetual follow-ups—represented a strategic area of growth,” the report notes. “Endocrinology and surgery departments gained volume and prestige, while hospital administrators gained a reliable revenue line that helps subsidize lower-margin services.”
The process for reversing many treatments, particularly those undertaken before or during puberty, serves to “further embed the patient in the medical system,” subjecting patients to still more expensive treatments, according to the report. Some patients who have medically transitioned later seek to “detransition,” HHS writes, and the report shares stories of several “detransitioners” who stopped or tried to reverse treatments they started during adolescence.
HHS Secretary Robert F. Kennedy Jr. Castigated medical associations in a press release announcing the report. “The American Medical Association and American Academy of Pediatrics peddled the lie that chemical and surgical sex-rejecting procedures could be good for children,” he said. “They betrayed their oath to first do no harm, and their so-called ‘gender-affirming care’ has inflicted lasting physical and psychological damage on vulnerable young people. That is not medicine — it’s malpractice.”
The report’s release builds on prior scrutiny of billing practices at major children’s hospitals. Court proceedings had already revealed that assessment times at Boston Children’s Hospital’s gender clinic collapsed from 20 hours or more in 2013 to two hours by 2018. In 2021, the director of its gender clinic admitted in a private video that the clinic was giving out puberty blockers “like candy.” Federal prosecutors have scrutinized major children’s hospitals for potential fraudulent billing, with DOJ filings noting a “large spike” in central precocious puberty diagnoses between 2020 and 2023, including at least one 22-year-old patient — diagnoses that defy medical logic since puberty at age 10 is biologically normal.
In the viral moment that intensified scrutiny of pediatric gender clinics, Texas whistleblower Dr. Eithan Haim exposed that Texas Children’s Hospital was engaging in fraudulent billing practices to hide transgender procedures on minors, including recording mastectomies as “breast reduction” surgeries and billing testosterone prescribed to a teen girl under a male diagnosis. The Biden DOJ had brought charges against Haim for alleged HIPAA violations, but the case was dropped under the Trump administration. Separately, nurse Vanessa Sivadge was terminated from Texas Children’s Hospital after blowing the whistle on doctors embarking children on dangerous courses of “gender-affirming” treatment after very little deliberation.
The second Trump administration’s approach to gender ideology has stood in stark contrast with the previous administration, which was “committed to advancing transgender equality … everywhere,” including in “our … healthcare systems,” as former President Joe Biden said. According to HHS, the Biden administration weaponized Section 1557 in the Affordable Care Act — which prohibits discrimination based on gender identity — applying it to healthcare professionals who refuse to provide gender treatments, or even punishing insurance companies for refusing to cover them.
Medical organizations pushed back against the HHS report. “This report misrepresents the current medical consensus and fails to reflect the realities of pediatric care,” an American Academy of Pediatrics statement read. “As we have seen with immunizations, bypassing medical expertise and scientific evidence has real consequences for the health of America’s children,” said AAP President Susan Kressly, MD.
The HHS report supports international reviews that have reversed course on pediatric gender medicine, including the U.K.’s Cass Review, which found “no good evidence on the long-term outcomes of interventions to manage gender-related distress.” The U.K. Has since moved to indefinitely ban puberty-blocking drugs on children outside clinical trials.
HHS writes that evidence indicates health providers may be committing fraud in several different ways, including inflated billings, deliberate misdiagnosing or misusing medical coding to defraud private insurance carriers and government programs including Medicaid and Medicare. The Trump administration has also moved to cut federal funding to hospitals providing gender-affirming care to minors, with HHS proposing rule changes that would apply to federal Children’s Health Insurance Program funding for these procedures on individuals under age 19.
The FDA is issuing warning letters to 12 manufacturers and retailers that market breast binders to children for treating gender dysphoria, FDA Commissioner Marty Makary announced.