There are wolves in Pennsylvania. And they’re wearing white coats.
A shocking new report from the U.S. Department of Health and Human Services reveals widespread fraud by doctors and hospitals involved in “gender medicine,” with evidence of shady insurance coding practices, perverse financial incentives, and provisions of sex-rejecting procedures for minors. It raises serious questions about the use of sex-rejecting interventions on children, and Pennsylvania taxpayers appear to have paid a significant portion of the bill.
As Vice President JD Vance said in response to the report:
“Parents bring their children to doctors because they trust them. They trust doctors to tell them the truth and they trust hospitals to put their children ahead of ideology and profit…When children may have been harmed and families misled, it’s on those of us in power to find the truth and to seek justice for kids who were harmed by these doctors.”
What’s in the report?
“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.” Executive Summary, Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine”
Over the course of the last decade, an industry has pushed the normalization of sex-rejecting interventions that has resulted in millions of dollars being spent and many young individuals suffering permanent consequences. Several tell their story in the report.
Clementine Breen, at just 14 years old, had a double mastectomy. At age 18, she detransitioned and now lives with a lifetime of regret and physical harm.
“Breen’s story is one of thousands,” writes Admiral Brian Christine, assistant secretary for health at the Department of Health and Human Services, and was involved in this report. “Children steered toward irreversible medicalization on the promise it would fix them and then left to face the damage alone.”
$76 Million From Pennsylvania Medical Assistance
The report also highlights findings released earlier this year by Daily Caller reporter Meg Brock, who uncovered more than $76 million in Pennsylvania Medical Assistance spending on four commonly prescribed puberty blockers—goserelin, histrelin, leuprolide and triptorelin—for patients 18 and under between 2020 and 2024.
The data included more than 1,900 claims for children ages 10–13 and more than 1,000 claims for those ages 14–18, with an average cost exceeding $11,200 per claim.
Puberty blockers are used as treatment for precocious puberty. But precocious puberty, by definition, occurs unusually early and blockers are generally discontinued by age 10-11. The HHS report raises concerns that providers have sometimes used broad endocrine diagnoses to obtain coverage for puberty blockers being used for other purposes.
In Pennsylvania, that question is particularly important given the millions of taxpayer dollars involved.
Who Is Responsible?
HHS identified more than $47 million in puberty-blocker claims involving children ages 9–17 in which the claim listed an endocrine-disorder diagnosis but did not include either a gender-related diagnosis or a precocious-puberty diagnosis. In other words, these claims used a general endocrine diagnosis without identifying either of the conditions that would ordinarily explain the use of puberty blockers.
The report’s claims data also identifies numerous organizations operating in Pennsylvania:
- Accredo Health Group
- Caremark
- CenterWell Pharmacy
- Chartwell Pennsylvania LP
- Children’s Hospital of Philadelphia
- Mount Nittany Physician Group
- PantherX Specialty
- PerformSpecialty
- ProCare Pharmacy Direct
- St. Luke’s Physician Group
- Walgreens
The volume of claims involving organizations operating in Pennsylvania underscores the need for a closer investigation into how these claims were coded, who authorized the treatments, and why Pennsylvania Medical Assistance paid them.
As HHS puts it, “The report recommends that federal and state agencies review coding and billing practices, strengthen oversight of claims submitted to public health programs, and refers suspicious billing activity for appropriate investigation when warranted.”
Another culprit in Pennsylvania: Planned Parenthood
Planned Parenthood operates three regions in Pennsylvania, and two of those regions were specifically mentioned in this HHS report for their vague diagnostic codes used in sex-rejecting interventions.
“According to a report in the Washington Examiner, “Planned Parenthood’s facilities in southeastern and western Pennsylvania describe giving insurance providers the billing code for ‘endocrine disorder, unspecified’ when prescribing transgender drugs. Planned Parenthood of Southeastern Pennsylvania’s website states, “In order to meet the needs of most insurance companies and patients, we typically use the code E34.9 (endocrine disorder, unspecified) and occasionally will use F64.9 (gender identity disorder, unspecified) if necessary. The language on the website also admits, “We recognize that much of the language around billing for gender affirming care is troublesome.” The website of Planned Parenthood’s western Pennsylvania location likewise says it may use the endocrine disorder code, offering the following disclaimer: “Note that while we don’t like the wording used in many of these codes, they are used by insurers and medical billers on a national basis and we are unfortunately required to keep the wording the same when using them because of that.” (pg 23)
How did this happen?
In a video released with the report, there’s an important detail explained by two of the report’s co-authors:
Dr. Brian Christine: “It’s not just our children paying or our families or even the insurers. Our findings show that false diagnosis coding for puberty blocker prescriptions has led [music] to over $47 million in fraudulent billing. It’s a cost borne by both public and private insurance. In the end, it’s paid for by you. But how did this happen? How did this culture of fraud and deception spring up right under our noses? Profit, pressure, and politics.
Dr. Aaron Kheriaty: Under the Biden administration, starting with an executive order about this issue and then continuing with various actions from various administrative state departments, there was a strong, inconsistent push to try to get coverage for sex rejecting procedures to get them paid for by various insurance companies or government entities or other benefits programs. So there was a strong push also from key personnel in the Biden administration. Admiral Lavine at the Department of Health and Human Services, for example, leaned heavily on some of the professional medical societies like the World Professional Association for Transgender Health to actually lower their recommended age requirements for certain interventions to do these sex rejecting procedures on younger and younger individuals.
The groundbreaking HHS report analyzed data from 2015 – 2025. Incidentally, Dr. Levine became Pennsylvania’s physician general in 2015.
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“So-called ‘gender-affirming care’ isn’t healthcare, it’s profit over people. It starts with a lie, and that lie has produced more lies: to parents, to patients, to payors.” – Alliance Defending Freedom Senior Counsel Hal Frampton
This new report underscores the need for more investigations into these organizations responsible for sex-rejecting interventions. Pennsylvania taxpayers deserve answers. And individuals like Chloe Cole and Clementine Breen deserve justice.
