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Mother Jones; Aaron Schwartz\/Pool\/CNP\/ZUMA<\/p>\n
\t\t\t\tGet your news from a source that\u2019s not owned and controlled by oligarchs. Sign up for the free Mother Jones Daily.<\/a><\/p>\n Just two days after finalizing a regulation<\/a> to make sure trans kids from low-income families can\u2019t afford puberty blockers or hormone therapy, the Trump administration has loosed another salvo in its bitter war against transgender people\u2019s healthcare. On Thursday, the Department of Health and Human Services published a report<\/a>\u2014authored largely by employees of right-wing advocacy groups\u2014alleging that some hospitals are using incorrect codes to bill insurance for pediatric gender-affirming care. The report paints transgender healthcare as motivated by profit rather than medical necessity, calling the billing codes \u201cpotentially fraudulent.\u201d<\/p>\n In a social media video<\/a>, Vice President JD Vance announced he was referring roughly 150 healthcare organizations listed in the report to the Department of Justice for criminal investigation. The list includes over a dozen major children\u2019s hospitals, pharmacies including Walgreens, and small doctors offices and clinics. Standing at Vance\u2019s side, HHS Secretary RFK Jr. added that he, too, was referring the providers for investigation by his department\u2019s inspector general.<\/p>\n \u201cIt\u2019s an intimidation campaign.\u201d<\/p>\n Yet advocates of transgender healthcare describe the HHS report released Thursday as part of a larger effort to shut down care. \u201cThis report is part of a broader pattern from this administration: Using the power of government to attack science and target health care providers instead of helping families get the care they need,\u201d says Kellan Baker, senior advisor for health policy at the Movement Advancement Project. \u201cIt\u2019s an intimidation campaign,\u201d adds Jennifer Levi, the director of transgender and queer rights at GLBTQ Legal Advocates & Defenders, pointing to ways the report might show up in future legal cases.<\/p>\n The HHS report\u2014provocatively titled \u201cWolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of <\/a>\u2018Gender Medicine<\/a>\u2018\u201d\u2014lambasts doctors\u2019 use of two diagnostic codes when prescribing puberty blockers. One of them, \u201cprecocious puberty,\u201d is generally used to describe early-onset puberty; the report argues that it\u2019s improper to use the same code for children delaying puberty while they take time to explore their gender identity. The other, \u201cendocrine disorder, unspecified,\u201d has been openly<\/a> described<\/a> for years<\/a> by some transgender healthcare providers as a way to avoid stigmatizing or using pathologizing language like \u201ctranssexualism\u201d or \u201cgender identity disorder.\u201d According to a 2021 journal article<\/a>, the \u201cendocrine disorder, unspecified\u201d code is \u201coften used to bill for transgender services to avoid\u00a0the stigma of\u00a0labeling the person as transgender, because no\u00a0[gender identity disorder]\u00a0is present, and\/or to avoid denials of payment.\u201d<\/p>\n The report frames these billing practices as a kind of fraud. And while this theory hasn\u2019t been fully tested in the courts, two recent settlements indicate it could be a successful angle of attack in the administration\u2019s broader project<\/a> to wipe out gender-affirming care for minors. Under pressure from the Trump administration over such billing practices, at least two hospitals\u2014Texas Children\u2019s Hospital<\/a> and Cleveland Clinic<\/a>\u2014agreed to settlements this year. Tellingly, their settlement agreements involved much more than adjusting their use of billing codes: Both hospitals agreed to stop gender-affirming treatments for minors entirely (though their states had already outlawed such treatments). They also agreed to set aside money to treat people who detransition. (Despite the heavy emphasis<\/a> on a small handful of detransition stories by activists who oppose all gender transitions, years of research have found regret rates of around 1 percent among adult<\/a> recipients<\/a> of gender-affirming surgery, and though there\u2019s less research on pediatric patients, the existing studies likewise<\/a> indicate<\/a> low regret rates.)<\/p>\n Though it bears the imprimatur of the federal government, much of the \u201cWolves in White Coats\u201d report contains material recycled from conservative policy groups like the Manhattan Institute and anti-trans activist groups like Do No Harm<\/a>. Five of its 10 authors\u2014including former White House senior policy strategist May Mailman, a close ally of Stephen Miller and the architect of the Trump administration\u2019s gender-related executive orders<\/a>\u2014are employees of the Independent Women\u2019s Forum, a faux-feminist conservative advocacy group often behind anti-trans messaging strategy. Another is Quentin Van Meter, past president of an old-school religious-right group of doctors that hold anti-LGBTQ positions<\/a> and call themselves, misleadingly, the American College of Pediatricians. Also on the author list is Eithan Haim, a Texas doctor who previously faced federal charges for\u00a0allegedly obtaining and leaking the private information of patients who weren\u2019t under his care. (Once Trump took office, DOJ prosecutors dropped the charges<\/a> against Haim.)<\/p>\n The actions of one author, Center for Christian Virtue president Aaron Baer\u2014whose group advocates \u201cfor public policy that reflects the truth of the Gospel\u201d\u2014immediately suggested that the report could provide political ammunition in the midterms. Shortly after its publication, Baer took to X to demand<\/a> that Ohio Democratic gubernatorial candidate Amy Acton and her running mate David Pepper comment on the Ohio healthcare providers flagged in the report. (Baer\u2019s group might see Acton as a soft target, after she made a statement<\/a> last month that misgendered trans girls as \u201cboys\u201d while saying she supported restrictions on their sports participation.)<\/p>\n But beyond its political utility, this report could turn out to be significant building block for the Trump administration\u2019s multi-pronged legal attacks<\/a> on providers of gender-affirming care. Despite Vance making a grand gesture on Thursday of referring providers for DOJ investigation, the department has already been investigating whether hospitals violated federal law by promoting off-label use of puberty blockers and hormones or by improperly billing the medications. As part of those investigations, the federal government has issued sweeping subpoenas for the private information of transgender children and teens receiving gender-affirming care.<\/p>\n The problem for the Trump administration is that federal judges have blocked these subpoenas almost<\/a> universally. Last fall in Massachusetts, for example, federal district judge Myong Joun quashed<\/a> a DOJ subpoena to Boston Children\u2019s Hospital for the medical records and personal information\u2014including home addresses and social security numbers\u2014of all patients who have received gender-affirming care as well as the personnel files of over a thousand employees.<\/p>\n \u201cIt is abundantly clear that the true purpose of issuing the subpoena is to interfere with the Commonwealth of Massachusetts\u2019 right to protect [gender-affirming care] within its borders, to harass and intimidate BCH to stop providing such care, and to dissuade patients from seeking such care,\u201d Joun wrote<\/a> in his order. \u201cThe Government seeks all this while not offering an iota of suspicion that BCH is actually engaging in fraudulent billing practices or off-label promotion in the first instance.\u201d <\/p>\n The report issued Thursday appears designed to provide that missing \u201ciota of suspicion\u201d\u2014potentially to allow the Trump administration to overcome the roadblocks it\u2019s been hitting in court. \u201cI think that\u2019s DOJ\u2019s plan,\u201d says Levi, who has been involved in efforts to fight the subpoenas.<\/p>\n The report also calls on private attorneys to join the Trump administration\u2019s efforts, urging them to file lawsuits accusing gender-affirming care providers of billing fraud, and raising the possibility of cash payouts to those who do.<\/p>\n