Vice President JD Vance is calling on the Department of Justice to investigate and pursue criminal prosecution against healthcare providers alleged to have fraudulently billed insurance companies for sex-change procedures performed on minors. The call comes after the release of a Health and Human Services report titled "Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of 'Gender Medicine.'"
The HHS report, obtained by Fox News Digital, details more than $60 million in insurance claims for treatments including puberty blockers billed for adolescents as young as 13 between 2015 and 2025. The report alleges that some providers aggressively treated children who presented with hormonal issues, endocrine system problems, or early onset puberty with transgender care, then billed insurance companies using diagnostic codes to secure coverage.
Vance sent a letter to Attorney General Todd Blanche requesting the DOJ investigate the findings and pursue criminal charges where appropriate. "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."
HHS Secretary Robert F. Kennedy Jr. separately sent a letter to HHS Inspector General Thomas March Bell containing a list of hospitals and clinicians that exhibit what the report describes as "potentially anomalous billing patterns" related to gender medicine.
What the Left Is Saying
Democratic lawmakers and LGBTQ+ advocacy organizations have criticized the Vance initiative, arguing that gender-affirming care for minors is medically necessary treatment supported by major medical associations. They contend the HHS report and subsequent calls for prosecution are politically motivated efforts to restrict healthcare access for transgender youth.
During the Biden administration, HHS issued guidance in March 2022 stating the department "unequivocally" confirmed "that gender affirming care for minors, when medically appropriate and necessary, improves their physical and mental health." That guidance was based on Affordable Care Act nondiscrimination provisions that included protections against sex discrimination.
Critics of the Trump administration approach argue that restricting coverage for these procedures leaves vulnerable patients without treatment options. Medicaid programs in multiple states had previously covered gender-transitioning treatments under Biden-era policies that required such coverage as part of nondiscrimination enforcement.
Progressive advocates contend that decisions about medical care for minors should remain between families, their doctors, and healthcare providers—not become subjects of federal criminal investigations. They point to peer-reviewed studies showing benefits of gender-affirming care when properly administered.
What the Right Is Saying
Republicans supporting the investigation argue that billing insurance companies for procedures using misrepresented diagnoses constitutes fraud regardless of the political context surrounding transgender medicine. They say the scale of the alleged scheme—$60 million in claims—warrants serious criminal scrutiny.
In his letter, Vance cited data from the HHS report showing that only about 4.7 percent of patients diagnosed with "endocrine disorder, unspecified" actually had that condition, while there was a 30 percent increase in endocrine disorder diagnoses despite it being unlikely that pediatric endocrine disorders have substantially increased. "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 report details average healthcare costs for minors at roughly $3,000 under typical treatment, compared to approximately $75,000 without surgery and nearly $170,000 with surgery for transgender treatments. The analysis found that about 225 hospitals and health systems across the country established pediatric gender programs during this period.
Trump administration officials argue these procedures constitute experimental treatments that should not have been covered by federal healthcare programs. HHS Secretary Kennedy's letter to the Inspector General specifically requested review of insurance coding practices enabling hospitals to file claims for gender medicine under different diagnostic codes.
Conservative lawmakers say they support protecting children from medical interventions they argue carry lifelong consequences, and they view alleged billing fraud as a separate but equally serious matter warranting prosecution.
What the Numbers Show
The HHS report documents more than $60 million in insurance claims for puberty blockers and related treatments billed through insurance from 2015 to 2025. The report specifically identifies adolescents as young as 13 among those who received puberty blocker treatments that were subsequently billed to insurance.
According to the analysis, average healthcare costs for a minor under standard treatment protocols run approximately $3,000. Gender-transitioning interventions without surgery average approximately $75,000 per patient, while procedures including surgery can reach nearly $170,000. The report notes these figures represent claims data analyzed across multiple insurance providers.
The report cites research indicating only 4.7 percent of patients diagnosed with "endocrine disorder, unspecified" actually had that condition according to the study referenced in Vance's letter. Additionally, there was a reported 30 percent increase in endocrine disorder diagnoses during this period despite what HHS characterized as it being unlikely that pediatric endocrine disorders have substantially increased.
Approximately 225 hospitals and health systems across the country established pediatric gender programs during the timeframe examined. The report includes data on billing patterns, diagnostic codes used, and insurance claims analysis compiled from multiple sources including peer-reviewed literature, hospital records, whistleblower testimony, and nationwide insurance claims data.
The DOJ had not responded to requests for comment as of publication time.
The Bottom Line
Vance's letter represents the most high-profile call yet for criminal prosecution related to transgender healthcare billing practices. If the DOJ moves forward with investigations, it could result in significant legal consequences for hospitals and individual providers identified in the HHS report.
The administration has signaled its intent to restrict federal funding for these procedures—the HHS report itself criticizes Biden-era policies that expanded coverage—and a successful prosecution would reinforce those restrictions while potentially deterring future billing practices deemed fraudulent. Healthcare providers performing gender-affirming care for minors will likely face heightened scrutiny of their diagnostic coding and insurance billing.
Medical associations including the American Academy of Pediatrics have previously maintained that gender-affirming care represents appropriate treatment for adolescents experiencing gender dysphoria, though some studies on long-term outcomes remain ongoing. Any DOJ prosecution would need to prove intentional fraud rather than good-faith medical judgment, a distinction likely to be central to any legal proceedings.
The case will test how federal prosecutors distinguish between contested medical practices and actionable insurance fraud, with implications for healthcare providers across the country who offer gender-transitioning treatments to minors.