The Trump administration escalated its campaign against gender-affirming care on Thursday, referring dozens of hospitals, clinics, and individual providers to the Department of Justice for potential prosecution over alleged fraudulent billing practices tied to transgender procedures.
Vice President JD Vance, who heads the White House’s Anti-Fraud Task Force, sent a letter to Attorney General Todd Blanche requesting a formal investigation. The move fuses two administration priorities: aggressive fraud enforcement and restricting gender-affirming care for minors.
The referral is based on a report from the Department of Health and Human Services (HHS) that alleges some pediatric gender clinics and children’s hospitals used misleading or fraudulent diagnostic and billing codes to secure insurance coverage for procedures. Vance wrote that such practices suggest providers were prioritizing financial gain over patient welfare.
The HHS report, titled “Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of ‘Gender Medicine,’” claims that approximately $50 million in insurance claims for puberty blockers were billed using an “unspecified” endocrine or hormone-related disorder code for children aged 9 to 17, rather than the more specific diagnosis of gender dysphoria. It also found nearly $11 million billed under a diagnosis of early puberty, despite the fact that, by definition, anyone 13 or older cannot have precocious puberty and should not receive puberty blockers at that age, according to HHS.
The report was released just two days after the Centers for Medicare and Medicaid Services cut off Medicaid funding to hospitals that offer gender-affirming care to minors. It was authored by contributors from policy, medicine, and media, many of whom represent conservative or religious organizations critical of gender-affirming care or have previously advocated against it.
HHS Secretary Robert F. Kennedy Jr. defended the report, stating: “Doctors and hospitals must put children’s health ahead of ideology and financial gain. 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.”
The administration argues that the findings undercut the notion that children are being steered into such care solely by “woke” ideology, instead pointing to profit motives. The report recommends that federal and state agencies review coding and billing practices, strengthen oversight of claims submitted to public health programs, and refer suspicious billing activity for appropriate investigation.
This development comes amid broader questions about administration transparency and as the White House continues to push controversial policies on multiple fronts. The DOJ has not yet announced a timeline for any investigation.
Critics, however, have already questioned the methodology and authorship of the HHS report, noting that it relies heavily on advocates with a known stance against gender-affirming care. They argue that the administration is using fraud allegations as a pretext to limit access to medically necessary treatments.
The move is likely to reignite debates over both medical ethics and the role of federal oversight in healthcare. It also signals that the administration is prepared to use its enforcement powers to target hospitals and providers that offer services it opposes, a tactic that could have broader implications for the healthcare industry.
