A US government-commissioned report has found that doctors and hospitals billed insurers and taxpayers tens of millions of dollars for child sex-change drugs. They did so, the report alleges, by labelling healthy children with hormone disorders they did not have.
Vice President JD Vance and Health Secretary Robert F Kennedy Jr referred the hospitals and clinics named in the report to the Department of Justice and the HHS Office of Inspector General on the day of its release. "Doctors and hospitals must put children's health ahead of ideology and financial gain," Kennedy said in a press release.
The Department of Health and Human Services (HHS) released the report, titled Wolves in White Coats, earlier this month. It found that more than 225 US hospitals and health systems had established "paediatric gender" programs, and that clinics nationwide billed close to $50 million for puberty-suppressing drugs using the code for "endocrine disorder, unspecified" -- a diagnosis unrelated to gender dysphoria.
Hospitals and clinics billed a further $11 million for 300 patients aged 13 to 17 using the precocious puberty code -- a condition that, by definition, cannot occur past early childhood.
According to the report, clinics used vague or incorrect diagnosis codes in order to secure insurance coverage for treatments that might otherwise have been refused by insurers.
Fenway Health, a Boston clinic affiliated with Harvard Medical School, told patients it could "sometimes use another, more vague diagnosis code," while acknowledging this "is not legal" under federal fraud law.
Planned Parenthood of Southeastern Pennsylvania's website stated that staff "typically use the code E34.9 (endocrine disorder, unspecified)" when prescribing cross-sex hormones.
A 2021 training slide for the World Professional Association of Transgender Health (WPATH) listed the same code under a section for treating "transgender/gender diverse adolescents."
Texas nurse Vanessa Sivadge told state lawmakers that she watched Texas Children's Hospital label a healthy boy with an "estrogen deficiency" and a healthy girl with a "testosterone deficiency" to justify prescribing them with cross-sex hormones. She said the hospital recorded patients' preferred sex rather than their birth sex, "creating a web of confusion and lies."
The report ties the growth of these programs partly to the Biden administration, which within hours of taking office in January 2021 declared it federal policy to treat restrictions on "gender-affirming care" as a form of discrimination. Federal agencies under Biden later pressed hospitals, insurers and even the military to cover the procedures.
The Trump administration has since reversed the policy and directed agencies to stop funding the procedures. Under Trump, the HHS has also opened a whistleblower portal for reports of "chemical and surgical mutilation of children."
Earlier this month, Texas Children's Hospital finalised a $10 million settlement and agreed to open the country's first hospital-run detransition clinic that will provide free care to patients for the first five years.
The Cleveland Clinic reached a separate resolution in June, paying $308,000 over alleged false billings and committing a further $2 million to provide care for detransitioners.
In Australia, scrutiny of "gender-affirming care" has so far focused on clinical governance rather than insurance fraud. Queensland's Cairns gender clinic was found to have a "negative patient safety culture" after prescribing puberty blockers to children as young as 12 without adequate assessment.
More than 100 Australian clinicians have called for a halt to youth gender interventions, citing the Family Court's finding in Re Devin that puberty blockers carried an "unacceptable" risk of harm.
Queensland psychiatrist Dr Jillian Spencer spent three years under AHPRA investigation for warning that puberty blockers posed risks to children, before being cleared of wrongdoing in July.
According to Freedom of Information data reported by The Australian, the gender service at Melbourne's Royal Children's Hospital saw 1,226 patients in 2024-25, 123 of whom started cross-sex hormones that year -- more than double the number who started hormone treatment in 2021-22, even as new referrals fell from a 2021 peak of 821 to 290.