A new HHS report says hospitals and clinics billed nearly $120 million for gender-related care for minors since 2019, and now face a federal probe.
A new HHS report on gender-care billing says hospitals and clinics billed nearly $120 million for gender-related medical treatment for minors since 2019, and the Trump administration has now opened a criminal investigation into whether fraud or other federal violations occurred. The report, titled “Wolves in White Coats,” says the practices harmed America’s youth and turned children’s hospitals and pediatric clinics into steady revenue machines.
The report says the billings covered more than 5,500 surgical procedures and 8,500 courses of hormone treatments. Among the largest billers were Mount Sinai Medical Center in New York and Boston Children’s Hospital, which HHS said billed $8.2 million and $6.5 million, respectively, for gender-related care from 2019 through 2023. The agency also said insurance fraud appears to be widespread, alleging that some providers used diagnosis codes such as endocrine disorder or precocious puberty to get claims paid or to protect patient privacy.
HHS argues that the money involved helps explain why the market for pediatric gender services expanded so quickly. The report says pediatric departments usually operate on thinner margins than other specialties, but gender clinics created a new and recurring source of income through hormones, surgeries and continuing follow-up visits. HHS wrote that the system created a continuous revenue stream for pediatrics, endocrinology and surgery by taking otherwise healthy young people and placing them into long-term medical care.
The report also lays out the cost of treatment in stark terms. Citing claims data and figures included in the document, HHS said average annual healthcare spending for a child under 18 is around $3,000, while hormone therapy can run $545 a year for androgens and $735 for estrogen. The agency said the puberty blocker GnRH can cost $16,385, and it said lifetime costs for someone starting treatment as a minor can reach $25,000 to $75,000 before surgeries are added. With operations included, HHS said total spending can exceed $100,000 and approach $170,000.
Background in the report shows how the Trump administration is framing the issue as both a medical and financial scandal. It says the previous Biden administration supported transgender equality in healthcare and used Section 1557 of the Affordable Care Act to press discrimination claims tied to gender identity. HHS now says providers may have used that environment to justify treatments, billing practices and coverage decisions that the department believes crossed legal lines. The report also says some patients later seek to detransition, and it includes accounts of people who say they started treatment in adolescence and later struggled with complications and the after-effects.
In releasing the report, Vice President JD Vance said in a letter to Attorney General Todd Blanche that the administration would not stand by while members of the medical community harmed children for profit. He said the matter was being referred to the Department of Justice for a federal criminal investigation and said the government would stop the fraud and restore trust in public health. HHS says the inquiry will examine whether providers named in the report committed fraud or violated federal law.
The report places hospitals, insurers and federal regulators at the center of a fight that has already reshaped medicine, politics and parental trust across the country. Supporters of gender medicine have argued for access and civil rights protections, while the Trump administration is now pressing the opposite case and treating the billing practices as a potential crime. For American families, the issue goes beyond policy labels: it touches on what children are being told, who profits from their care and whether public insurance programs are being used properly. What happens next will depend on the federal investigation and any findings that follow, but the central takeaway is simple: the administration is turning gender-care billing into a high-stakes federal fraud case.
