The federal government has referred dozens of hospitals, pharmacy benefit managers and pharmacies to investigators over potentially fraudulent billing related to pediatric gender-affirming care.
Vice President JD Vance referred hospitals and clinics identified in a new HHS report to the Justice Department, while HHS Secretary Robert F. Kennedy Jr. referred flagged organizations to HHS’ Office of Inspector General over “potentially anomalous billing patterns” identified through an analysis of insurance claims, according to an Aug. 13 news release.
Organizations Mr. Kennedy referred to federal investigators include some of the nation’s largest health systems, such as Oakland, Calif.-based Kaiser Permanente, Nashville, Tenn.-based HCA Healthcare, Renton, Wash.-based Providence, NYU Langone and Dallas-based Baylor Scott & White Health. Other prominent organizations include CVS Caremark, Walgreens, Cigna’s Accredo, Optum, Humana’s CenterWell and Prime Therapeutics.
In the report, HHS shared its analysis of claims data spanning 2015 to 2025, identifying $47.6 million in claims for puberty-blocking drugs prescribed to patients 9 to 17 years old with endocrine disorder diagnoses, excluding precocious puberty. The patients also did not have a gender-related diagnosis documented. Of those claims, $42.6 million stemmed from an unspecified endocrine disorder diagnosis, the report said.
“This data strongly suggests a pattern of potentially fraudulent billing that relies on miscoding for endocrine disorders to justify the prescription of puberty blockers,” the report said.
The department also identified roughly $11 million billed for puberty blockers prescribed to patients between 13 and 17 years old with a diagnostic code for precocious puberty, which HHS said should apply to a younger age range. The report also included a list of providers that billed same-day gender dysphoria diagnoses and cross-sex hormone prescriptions for minors from 2023 to 2026 in states with relevant care bans.
The report comes days after CMS finalized a rule that will cut off federal Medicaid and CHIP funds for certain gender-affirming care provided to minors.
The referrals mark the latest escalation in a federal crackdown on pediatric gender-affirming care that began shortly after President Donald Trump returned to office in January 2025. Some pediatric hospitals, most recently Hartford-based Connecticut Children’s Medical Center, have struck deals with the Justice Department and stopped providing gender-affirming care services.
The American Hospital Association declined to comment on the report.
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