A day after the Trump administration ended federal funding of "sex-rejecting procedures on children," otherwise known as gender affirming care, Vice President J.D. Vance and Health and Human Services Secretary Robert F. Kennedy Jr. referred hospitals and gender clinics identified in a new HHS billing fraud report for prosecution and investigation.

Vance's letter to Attorney General Todd Blanche asks the Justice Department to investigate whether flagged providers violated the Food, Drug, and Cosmetic Act, False Claims Act and federal fraud and conspiracy laws by "intentionally" miscoding treatment to "secure insurance coverage for gender-transitioning interventions that insurance would not otherwise cover." If so, "they should go to prison."

"More than just pushing these procedures on kids, hospitals and providers may have been defrauding Medicaid and private insurers by using misleading or fraudulent billing codes to get insurance to cover the costs," Vance said in an X thread on the report and criminal referral.

Kennedy's letter to HHS Inspector General T. March Bell asks him to review "an objectively defined cohort of claims that exhibit potentially anomalous billing patterns" by hundreds of flagged providers in the HHS report, which may violate federal law. 

The secretary's letter identifies four fishy cohorts: claims for puberty blockers with endocrine disorder diagnosis on the same claim with "no gender diagnosis" and "no precocious puberty" diagnosis, ages 9-17; claims for puberty blockers with precocious puberty diagnosis, 13-17; claims for "primary gender dysphoria" diagnosis with a cross-sex hormone prescription "written the same day" in a state where that's prohibited for minors, 17 and younger; and affiliates to whom prescribers billed at least 95% of their claims in a prescription year and are registered at one of their addresses, all of them Planned Parenthood clinics.