A report from the Department of Health and Human Services (HHS) alleges that U.S. hospitals and clinics have generated nearly $120 million in revenue since 2019 through gender-related medical treatments for minors. The report, titled “Wolves in White Coats,” claims that financial incentives may have driven healthcare providers to offer and promote costly gender interventions for young patients, potentially leading to lifelong medical dependency.
The HHS report further suggests that insurance fraud is widespread, with evidence indicating that pediatric gender clinics and children's hospitals have engaged in deceptive billing practices to secure payment for treatments. These findings have prompted the Trump administration to initiate a federal criminal investigation into alleged fraud and violations of federal law by providers.
According to the report, which spans approximately a decade of alleged practices, major children's hospitals, including Mount Sinai Medical Center in New York and Boston Children's Hospital, were among the facilities with the highest billings. These institutions collectively billed millions for gender-related care between 2019 and 2023.
The report posits that hospitals pursued gender care for minors as a new revenue stream to boost profits in pediatric departments, which typically have lower profit margins than other medical specialties. By treating physiologically healthy young individuals, these clinics allegedly created a continuous source of revenue through ongoing treatments, including hormone therapies and surgeries.
HHS estimates that since 2019, over 5,500 surgical procedures and 8,500 courses of hormone treatments for minors have been billed. The agency accuses healthcare providers of misusing diagnostic codes, such as those for endocrine disorders or precocious puberty, to obtain insurance coverage or protect patient privacy.
The report highlights the cost of these treatments, noting that while annual healthcare spending for a child under 18 averages around $3,000, hormone therapy can range from $545 to $735 annually, with puberty blockers costing approximately $16,385 per year. Lifetime costs for minors undergoing hormone treatments can range from $25,000 to $75,000, potentially exceeding $100,000 to $170,000 when surgeries are included.
“Wolves in White Coats” also includes accounts of individuals who have detransitioned, describing experiences of confusion during adolescence, rapid progression to medical interventions, and subsequent complications. The report suggests that some doctors did not connect post-treatment complications to initial interventions or provide guidance upon patients ceasing treatments.
In response to the report, Vice President JD Vance announced the referral of the matter to the Department of Justice for a federal criminal investigation. He stated, "This Administration will not stand idly by while some in the medical community harm our children in search of profit." The report contrasts the current administration's approach with that of the previous Biden administration, which it claims advanced transgender equality in healthcare and utilized Section 1557 of the Affordable Care Act to protect gender-affirming care.