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Wolves in White Coats: Hospitals Billed $ 120 Million For Juvenile Sex-change Procedures

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The charges since 2019 included over 5,500 surgeries and 8,500 courses of hormones or puberty blockers, according to a new report commissioned by the Department of Health and Human Services (HHS).  The report is titled: Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine".

Some providers used misleading or potentially fraudulent billing codes to get insurers to cover the interventions, according to HHS. The department identified nearly $ 50 million in claims for puberty blockers given to children aged nine to 17 under a general hormone-disorder code without a gender-related or early-puberty diagnosis on the same claim.

Hospitals and clinics identified in the report have been referred to the Department of Justice and investigators from the Department of Health and Human Services (HHS) for potential violations of federal law. According to HHS, the observed billing patterns require additional investigation.

Another $ 11 million was billed for puberty blockers for hundreds of patients aged 13 to 17 under a diagnosis for unusually early puberty. HHS said that this diagnosis does not apply at those ages.

The report said the procedures offered hospitals a long-term source of revenue, as minors who begin hormone drugs can remain in medical care for years. Citing outside estimates, it put lifetime costs at up to $ 75,000 without surgery and as much as $ 170,000 when operations are included.

Here is the HHS Executive Summary of this 64 page report:

https://www.hhs.gov/sites/default/files/hhs-wolves-white-coats-executive-summary.pdf

https://www.hhs.gov/sites/default/files/hhs-wolves-in-white-coats.pdf

Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine”
A report commissioned by the U.S. Department of Health and Human Services

EXECUTIVE SUMMARY

In the 2010s, financial incentives contributed to the rapid expansion of pediatric gender clinics and programs by creating long-term revenue opportunities for these medical establishments. Unlike most traditional pediatric services, which involve episodic or short‑term care, children receiving puberty blockers, cross-sex hormones, surgeries, and related services may require recurring endocrinology visits, laboratory monitoring, prescriptions, mental‑health services, surgical procedures, and follow‑up care extending into adulthood. This pediatric medical field effectively creates “captive patients.”

All‑payer claims and cost data indicate nearly $120 million in billed charges for sex‑rejecting procedures involving minors since 2019. These charges include more than 5,500 surgical procedures and 8,500 courses of hormones or puberty blockers. The analysis concludes that these continuing interventions have created financially valuable patient populations for hospitals and associated specialties.

  • Cross-sex hormone therapy entails average yearly payer costs per patient ranging between $545 (androgens), $735 (estrogens), and $16,385 (for the more costly puberty-blocker GnRH). Surgical interventions, such as mastectomies, mammoplasties, and phalloplasties, can range from $12,000 to over $130,000.

Potentially Fraudulent Medical Coding

An analysis of the data suggests that some providers may have used diagnosis codes that did not accurately reflect patients' underlying conditions in order to obtain insurance coverage for sexrejecting procedures, particularly with ICD-10 code E34.9 (“endocrine disorder, unspecified”) and the ICD-10 codes for central “precocious puberty.”

  • Between 2015 – 2025, public and private insurance was billed nearly $50 million for puberty blocking drugs in patients aged 9-17 with Endocrine Disorder diagnoses (excluding precocious puberty, the typical indication for puberty blockers).
  • During this same timeframe, nearly $11 million was billed for puberty blockers, including to Medicaid and Medicare, for hundreds of patients between the age of 13 and 17 with a diagnostic code for precious puberty. By definition, anyone 13 or older cannot have a diagnosis of precocious puberty and should not be given puberty blockers at that age for this indication

Federal Policy and Institutional Pressure

The Biden Administration, particularly HHS, under the leadership of Secretary Becerra and Admiral Levine, contributed to the expansion and normalization of sex-rejecting interventions through nondiscrimination policies, insurance requirements, agency guidance, litigation positions, federal employee benefits, and other federal programs.

Influence of Professional Medical Organizations

Organizations like World Professional Association for Transgender Health, the Endocrine Society, the American Psychological Association, and the American Academy of Pediatrics contributed to the promotion of pediatric sex-rejecting interventions, even while undercutting their own evidence base. This professional network created an institutional environment in which sex-rejecting medical interventions became increasingly accepted, while opposing clinical perspectives, uncertainties, and potential risks that caused irreversible damage received insufficient consideration.

Patient and Parent Experiences

Eight first-hand testimonies from patients and parents illustrate weakness in clinical safeguards and informed-consent processes. Common themes include distress related to a child’s sex and rapid medical interventions, insufficient examination of underlying psychological, developmental, social, or trauma-related factors, limited discussion of irreversible damage, pressure placed on parents to
approve “treatment,” adverse physical and psychological outcomes, and difficulty obtaining appropriate medical care after stopping treatment or detransitioning. These testimonies underscore the imbalance between the structured healthcare pathways available for initiating medical transition and the comparatively limited clinical infrastructure available to patients seeking to discontinue treatment, address complications, or detransition.

Conclusion

The expansion of pediatric sex-rejecting procedures resulted from an interaction among financial incentives, potentially illegal billing practices, ideological and professional influences, federal policy, and inadequate oversight. The medical establishment and the government failed innocent children. This report exposes how these calculated financial and political efforts left children irreversibly harmed and abandoned at the very moments when they needed real support.


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Vice President J.D. Vance and Health and Human Services Secretary Robert F. Kennedy Jr. have now referred hospitals and gender clinics identified in the HHS report titled: Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine" to Attorney General Blanche for prosecution:

https://justthenews.com/politics-policy/health/vance-kennedy-refer-gender-clinics-prosecution-based-hhs-billing-fraud-probe

Vance, Kennedy refer gender clinics for prosecution based on HHS billing fraud probe
If flagged providers were "intentionally" miscoding treatment to "secure insurance coverage for gender-transitioning interventions that insurance would not otherwise cover," Vance says "they should go to prison."
By Greg Piper - August 13, 2026

A day after the Trump administration ended federal funding of "sex-rejecting procedures on children," otherwise known as gender affirming care, Vice President J.D. Vance and Health and Human Services Secretary Robert F. Kennedy Jr. referred hospitals and gender clinics identified in a new HHS billing fraud report for prosecution and investigation.

Vance's letter to Attorney General Todd Blanche asks the Justice Department to investigate whether flagged providers violated the Food, Drug, and Cosmetic Act, False Claims Act and federal fraud and conspiracy laws by "intentionally" miscoding treatment to "secure insurance coverage for gender-transitioning interventions that insurance would not otherwise cover." If so, "they should go to prison."

"More than just pushing these procedures on kids, hospitals and providers may have been defrauding Medicaid and private insurers by using misleading or fraudulent billing codes to get insurance to cover the costs," Vance said in an X thread on the report and criminal referral.

Kennedy's letter to HHS Inspector General T. March Bell asks him to review "an objectively defined cohort of claims that exhibit potentially anomalous billing patterns" by hundreds of flagged providers in the HHS report, which may violate federal law.

The secretary's letter identifies four fishy cohorts: claims for puberty blockers with endocrine disorder diagnosis on the same claim with "no gender diagnosis" and "no precocious puberty" diagnosis, ages 9-17; claims for puberty blockers with precocious puberty diagnosis, 13-17; claims for "primary gender dysphoria" diagnosis with a cross-sex hormone prescription "written the same day" in a state where that's prohibited for minors, 17 and younger; and affiliates to whom prescribers billed at least 95% of their claims in a prescription year and are registered at one of their addresses, all of them Planned Parenthood clinics.


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One of the original Texas whistleblowers sees the hospital who fired her do a 180.

https://www.dailysignal.com/2026/08/14/sivadge-story-detransition-clinic/

Vanessa Sivadge Shares the Story Behind America’s First-Ever Detransition Clinic

Emma Dayton    |    August 14, 2026

In a historic $10 million settlement, Texas Children’s Hospital agreed to open the nation’s first-ever detransition clinic by October and fire five physicians after the hospital allegedly funded gender-transition procedures using Texas Medicaid.

Vanessa Sivadge, the whistleblower who sounded the alarm in May 2023, explained that working as a nurse at Texas Children’s Hospital was a dream come true.

“I thought I had peaked in my career,” Sivadge said during an appearance before grassroots leaders at Heritage Action’s Southwest Sentinel Summit in Phoenix this month.

“I thought this was going to be my dream job where I would be for the rest of my life,” she said.

Sivadge recalled watching Texas Children’s Hospital “sell a lie” to struggling children and make them “a slave to the pharmaceutical industry for life” through permanent gender-transition procedures.

“They were promised that on the other side of medical transition, that they would find fulfillment and happiness and peace,” Sivadge said. “That is the lie of the gender medicine industry. It convinces and exploits children to believe that they were born into the wrong body, that they are not fearfully and wonderfully made, and that their confusion will resolve on the other side of a drug or a surgery.”

Sivadge told the crowd of grassroots leaders that this spiritual attack on God’s design of “male and female” eventually forced her to expose the “darkness.”

“So, with a lot of fear and with a lot of tears and a lot of uncertainty, I called a journalist in May of 2023,” Sivadge said. “That is when, anonymously, I blew the whistle against the secret transgender medicine program that Texas Children’s Hospital was conducting.”

While she thought no one knew her identity, Sivadge was shocked when two agents from the Biden-Harris Federal Bureau of Investigation knocked on the front door of her home. Sivadge explained that the FBI agents proceeded to intimidate and threaten her to remain silent about the alleged Medicaid fraud.

Yet what she characterized as a scare tactic had the opposite of its intended effect.

“I often say now that if the FBI hadn’t come to our home and hadn’t threatened my career, my safety, I don’t think that I would have been as emboldened as I was to do what happened next,” Sivadge said.

Sivadge came forward publicly in June 2024 after seeing three ways the hospital was allegedly committing fraud: failing to list the biological sex on claims; using false diagnoses to receive reimbursements; and filing for Medicaid when Texas clearly forbids taxpayer-funded gender procedures.

Texas Children’s Hospital fired Sivadge two months later, and the nurse was unable to find other employment after the hospital began making public statements. Sivadge finally found an ally in President Donald Trump when he assumed office in 2025. One week after she testified in a congressional hearing on ending lawfare toward whistleblowers who protect children, the Department of Health and Human Services launched a formal investigation.

“The most important and the most profound action that was taken was that they opened a whistleblower tip line for the first time ever, where they invited the public to submit tips on this publicly accessible tip line under HHS,” Sivadge said.

She believes the new detransition clinic will provide hope to those who are victims of gender procedures.

“This will be the first clinic of its kind where not just victims from Texas, but victims from America, victims from all over the world will be able to come and get free mental and medical care for the first five years,” Sivadge said.

Sivadge is now the president of Protecting Texas Children, an organization she founded to advocate for Texas children to “fulfill their God-given potential.” She continues to speak up on the realities of “radical gender ideologies” and encourages others to advocate for the rights of children.

“My advocacy has just changed addresses,” Sivadge said. “Before it was in the hospital, and now it’s in the capital.”

“Each one of you has an opportunity to expose darkness and to embrace what is right and good and beautiful and true,” Sivadge said. “And so, that would be my encouragement to each of you, is to choose courage.”



   
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