RESOLVING THE LEDGER
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See the full story · 1 sourcesThe move is the latest by the administration to emphasise “biological sex” and investigate access to gender-affirming care and other services to transgender individuals.
Listen BOSTON - The Trump administration referred over 200 hospitals and clinics to the Justice Department and Inspector General at the Department of Health and Human Services, seeking investigations into what it says are possible violations of federal statutes related to pediatric gender-affirming care and warning of possible harsh penalties for offenders.
Major hospitals including Boston Children’s Hospital and pharmacy providers like Cigna‘s Accredo Health Group are among those referred to the investigatory bodies over concerns that billing claims require further scrutiny.
The move is the latest by the administration to emphasise “biological sex” and investigate access to gender-affirming care and other services to transgender individuals, ranging from HHS rulemaking to DOJ and Federal Trade Commission probes of medical groups that support transgender health services. On Aug 11, HHS finalised a rule that would restrict federal Medicaid funding from covering forms of gender-affirming care for minors.
“Given the seriousness of these potential violations, HHS requests that HHS OIG swiftly evaluate this referral,” Health Secretary Robert F. Kennedy Jr. wrote in a letter to HHS Inspector General T. March Bell dated Aug 12.
The letter cites data from a report publicly released by HHS on Thursday that Kennedy says “identifies an objectively defined cohort of claims that exhibit potentially anomalous billing patterns” over a ten-year period.
Treatments used for individuals experiencing gender dysphoria are often used to treat other conditions such as certain endocrine disorders or precocious puberty. The administration said it’s looking at whether providers used billing codes for these conditions to mask billing for treatment of pediatric gender dysphoria.
Kennedy groups the referred institutions into four groups.
The first three groups consist of health facilities and pharmacies. The first issued claims for puberty blockers for children 9-17 with endocrine disorders on the same claim as a “no gender” diagnosis or precocious puberty diagnosis. The second group of institutions issued claims for children ages 13-17 for puberty blockers with a precocious puberty diagnosis on the same claim.
The third category issued claims for a primary gender dysphoria diagnosis for an individual 17 or younger with a cross-sex hormone prescription on the same day, in a state that banned this procedure for minors during the service provided.
The fourth group, which only includes Planned Parenthood affiliates, are called out because of a high number of claims flagged to its affiliate.
Vice President JD Vance, in a letter to Attorney General Todd Blanche, asked DOJ to determine whether the providers included in the report violated any federal laws or regulations including the False Claims Act, the Federal Food, Drug, and Cosmetic Act, and any other fraud or conspiracy laws.
“When providers miscode treatment in order to secure insurance coverage for gender-transitioning interventions that insurance would not otherwise cover, they should be held accountable. If they have done so intentionally, thereby perpetrating a fraud on Medicaid or on private insurers, they should go to prison,” wrote Vance. BLOOMBERG
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