Vice President JD Vance has taken a significant new step following the release of a federal investigation, putting the findings directly in the hands of the nation’s top law enforcement officials.
The vice president says that if investigators determine certain conduct outlined in the report was intentional, those responsible shouldn’t merely face professional consequences.
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Vance referred findings from a new Department of Health and Human Services report examining pediatric gender medicine and insurance billing practices to Attorney General Todd Blanche and the Department of Justice for review of potential violations of federal law.
The HHS report, titled “Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of ‘Gender Medicine,’” examines insurance coding associated with treatments including puberty blockers and cross-sex hormones provided to minors.
According to HHS, more than 225 hospitals and health systems established pediatric gender programs across the United States.
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Nationwide insurance claims data covering 2015 through 2025 identified approximately $50 million in claims for puberty-blocking drugs billed using the diagnostic code for “endocrine disorder, unspecified,” according to the report.
HHS also identified nearly $11 million in claims involving patients between 13 and 17 years old that were billed using a precocious puberty diagnosis code.
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The report says precocious puberty diagnoses would typically be inappropriate for patients older than 13.
All-payer claims data cited by HHS additionally showed nearly $120 million in billed charges since 2019 for related procedures involving minors, including more than 5,500 surgical procedures and approximately 8,500 courses of hormones or puberty blockers.
HHS Secretary Robert F. Kennedy Jr. has separately referred a defined group of claims displaying what the department described as potentially anomalous billing patterns to the HHS Inspector General.
Those claims include puberty blockers paired with an unspecified endocrine disorder diagnosis without accompanying gender dysphoria or precocious puberty codes for patients between 9 and 17 years old.
The referral also covers claims using precocious puberty codes for patients ages 13 through 17 and certain same-day cross-sex hormone prescriptions accompanied by a primary gender dysphoria diagnosis in states restricting those treatments for minors.
Vance highlighted some of the report’s findings in his letter to Blanche.
“One study showed that only about 4.7 percent of patients diagnosed with ‘endocrine disorder, unspecified,’ had that actual condition,” Vance wrote.
“Another notes a 30 percent increase in the number of endocrine disorder diagnoses, despite it being unlikely that there has been a substantial increase in pediatric endocrine disorders,” he continued.
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“When providers miscode treatment in order to secure insurance coverage for gender-transitioning interventions that insurance would not otherwise cover, they should be held accountable,” Vance wrote.
“If they have done so intentionally, thereby perpetrating a fraud on Medicaid or on private insurers, they should go to prison,” the vice president added.
The report also examined the financial costs associated with the treatments, arguing that the potential revenue involved creates incentives warranting further scrutiny.
HHS said average annual healthcare costs for a minor are approximately $3,000, while treatment pathways involving the interventions examined by the department could reach approximately $75,000 without surgery and nearly $170,000 when surgery is included.
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“Rather than allow the proliferation of harmful, sex-rejecting procedures on our children, we must send a clear message that any hospitals and providers that have participated in these practices will face justice,” Vance wrote.
The referral follows the Trump administration’s decision to end federal Medicaid and Children’s Health Insurance Program funding for sex-rejecting procedures involving minors.
The Justice Department has not publicly announced whether it will open criminal investigations or pursue prosecutions based on Vance’s referral.
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🚨 WOW. It was just exposed by JD Vance and Robert F. Kennedy Jr. that hospitals who billed for child transgender operations cost up to $170,000 DOLLARS
For TOTALLY unnecessary and manipulation-induced operations.
The hospitals have now been referred to DOJ for federal law… pic.twitter.com/uosjPQGjYd
— Eric Daugherty (@EricLDaugh) August 13, 2026
For now, Vance has placed the matter before Blanche and the Justice Department with an unmistakable recommendation if investigators find evidence of intentional fraud.
“They should go to prison,” Vance said.
This article may contain commentary which reflects the author’s opinion.
