A new report from the Department of Health and Human Services (HHS) alleges that some healthcare professionals and institutions profited significantly from pediatric gender-affirming procedures, engaging in fraudulent practices to secure insurance coverage for treatments like puberty blockers and surgeries.
The report, titled “Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of ‘Gender Medicine,’” details how vulnerable children were allegedly steered toward a lifelong path of medicalization, often without full understanding of the implications.
Clementine Breen, who underwent a double mastectomy at age 14 after being placed on puberty blockers at 12 and testosterone at 13, shared her experience of facing complications from these interventions. Breen detransitioned at age 18 and has since dealt with irregular menstrual cycles, hormonal instability, chest pain, and vaginal atrophy. She noted that one former doctor cut off communication upon learning of her detransition and that an OB-GYN admitted no standard care plan exists for her history.
Breen’s story is presented as one of thousands where children allegedly underwent irreversible medical treatments promised to resolve their discomfort, only to be left with lasting complications. The authors, identifying as physicians, argue that these practices violate the medical oath to “do no harm.”
The HHS report indicates that the financial incentives for these procedures were substantial. A single mastectomy can yield over $12,000 from insurers, and complex surgeries can exceed $100,000. A watchdog database tracking billing for minors reported nearly $120 million in charges nationwide for surgeries and hormone therapies since 2019.
Major academic medical centers and children's hospitals were cited as high-grossing providers. Mount Sinai Medical Center in New York reportedly billed over $8 million, and Boston Children’s Hospital billed more than $6.5 million for these services to minors between 2019 and 2023. Many of these institutions participate in Medicaid and Medicare.
According to the report, providers may have secured insurance coverage through potentially fraudulent diagnoses. Minors were allegedly diagnosed with conditions such as endocrine disorders or precocious puberty to justify treatments that insurers might otherwise deny. Between 2015 and 2025, nearly $50 million was billed to insurers for puberty blockers prescribed to children aged nine to 17 under an endocrine disorder diagnosis. An analysis found a 30% rise in such diagnoses among minors between 2020 and 2022. The report also noted nearly $11 million billed for puberty blockers for patients aged 13 to 17 under a precocious puberty diagnosis, despite the definition of precocious puberty precluding individuals 13 and older.
The report suggests these findings could expose providers and institutions to civil and criminal liability.
The article notes that these developments occurred following a 2021 executive order from President Biden declaring it the policy of his administration to combat discrimination based on gender identity. HHS subsequently announced that refusing to provide or cover gender-affirming procedures would be treated as illegal sex discrimination.
Medical associations like the World Professional Association for Transgender Health and the Endocrine Society issued guidelines that, according to the report, were not grounded in scientific evidence but rather political dictates, potentially pressuring physicians who might have exercised caution.
The authors of the report and the opinion piece, including Admiral Brian Christine, assistant secretary for health at HHS, call for a reckoning within the medical profession and its governing institutions to address the alleged betrayal of patient trust and to hold accountable those responsible.