‘Wolves in White Coats’: HHS finds $50M in fraudulent billing to hide sex-change procedures on kids

The U.S. Department of Health and Human Services released a report Thursday alleging that hospitals and doctors used incorrect medical billing codes to obtain insurance payments for puberty blockers, cross-sex hormones and irreversible sex-change surgeries performed on minors.

The 64-page report, titled “Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of ‘Gender Medicine,'” reviewed nationwide insurance claims from 2015 to 2025. It found that nearly $50 million was billed to public and private insurers for puberty-blocking drugs administered to patients ages 9 to 17 using the code E34.9, “Endocrine Disorder, Unspecified” — a diagnosis code that doesn’t reference gender dysphoria.

According to the report, 239 puberty-blocker patients had their treatment billed under that code, generating more than $42 million in claims. Additional patients were billed under other vague codes, including “Other Specified Endocrine Disorders” (50 patients, more than $2 million) and “Androgen Insensitivity Syndrome, Unspecified” (48 patients, more than $1 million). Medicaid paid nearly $8 million of the endocrine-code claims, with smaller amounts through Medicare and other government programs.

The report also identified $11 million in puberty blocker claims coded as “Precocious Puberty,” a diagnosis for children whose puberty begins abnormally early and that doesn’t clinically apply to patients ages 13 or older. HHS said 300 patients, including teenagers older than the diagnosis’ applicable age range, had claims billed this way. “Doctors submit medical codes so that insurers can understand what physicians did (the treatment or CPT code) and why they did it (the diagnosis or ICD code).”

According to the report, “If the treatment (CPT code) is medically necessary for the diagnosis (reflected by the ICD code), then the insurer will more likely reimburse the provider for the service. Similarly, if the treatment is not medically necessary for the diagnosis, the insurer is less likely to provide coverage.”

The report cites a resource titled “Trans in the South: A Guide to Resources and Services,” which it says provided hospitals and providers with a chart listing diagnosis codes “commonly rejected” by insurers alongside alternative codes “commonly accepted” for the same procedures.

The guide recommended billing a vulvoplasty under the code for “vulvar pain,” a mastectomy under “mastodynia,” and hysterectomy under one of four unrelated codes, including “irregular menses” or “pelvic pain.” It also cited codes for “ovarian cyst” in place of oophorectomy, and “hypertrophy of the clitoris” or “labial hypertrophy” in place of clitoroplasty and labiaplasty, respectively.

The report separately cites internal data from Children’s Hospital of Philadelphia showing that between 2017 and 2024, nearly 250 minors were first diagnosed at CHOP or an affiliated provider with central precocious puberty at age 10 or older, including patients ages 14 to 18. It also cites a Pennsylvania Department of Human Services dataset showing a more than 2,100% increase between 2013 and 2017 in reimbursements for puberty blocker claims coded as precocious puberty.

“Healthcare providers can misuse this common language to defraud insurers,” the report states.

The HHS adds that these intentionally false billings totaling nearly $50 million are a potential violation of the False Claims Act. 

Vice President JD Vance, who leads the White House’s anti-fraud task force, referred the report to Attorney General Todd Blanche and requested a Justice Department investigation.

“For years now, some hospitals and healthcare providers have been subjecting children to horrific, experimental treatments in service of radical gender ideologies,” Vance wrote on X. “Today, thanks to the Wolves in White Coats report released by @HHSGov, we know why: profit.” He said providers who miscode treatment “should be held accountable.”

HHS Secretary Robert F. Kennedy Jr. said the findings warrant further scrutiny. “Doctors and hospitals must put children’s health ahead of ideology and financial gain,” Kennedy said in a statement.

“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. Under President Trump’s leadership, we are restoring transparency and integrity to American medicine,” he added. 

CMS Administrator Dr. Mehmet Oz said the agency would examine the claims.

“When billing practices obscure what care was actually provided, especially when children are involved, we have an obligation to follow the facts,” Oz said. “We will protect the integrity of our programs, demand accountability, and make sure the American people are not footing the bill for sex-rejecting procedures that inflict potentially [remainder of quote not provided].”