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THE TRUMP ADMINISTRATION LAUNCHES A NEW ANGLE OF ATTACK AGAINST TRANS
HEALTHCARE  
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Madison Pauly
August 18, 2026
Mother Jones
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_ Federal officials referred around 150 healthcare organizations for
investigation into allegations of fraud. _

, Mother Jones; Aaron Schwartz/Pool/CNP/ZUMA

 

Just two days after finalizing a regulation
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to make sure trans kids from low-income families can’t afford
puberty blockers or hormone therapy, the Trump administration has
loosed another salvo in its bitter war against transgender people’s
healthcare. On Thursday, the Department of Health and Human Services
published a report
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largely by employees of right-wing advocacy groups—alleging that
some hospitals are using incorrect codes to bill insurance for
pediatric gender-affirming care. The report paints transgender
healthcare as motivated by profit rather than medical necessity,
calling the billing codes “potentially fraudulent.”

In a social media video
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Vance announced he was referring roughly 150 healthcare organizations
listed in the report to the Department of Justice for criminal
investigation. The list includes over a dozen major children’s
hospitals, pharmacies including Walgreens, and small doctors offices
and clinics. Standing at Vance’s side, HHS Secretary RFK Jr. added
that he, too, was referring the providers for investigation by his
department’s inspector general.

“It’s an intimidation campaign.”

Yet advocates of transgender healthcare describe the HHS report
released Thursday as part of a larger effort to shut down care.
“This report is part of a broader pattern from this administration:
Using the power of government to attack science and target health care
providers instead of helping families get the care they need,” says
Kellan Baker, senior advisor for health policy at the Movement
Advancement Project. “It’s an intimidation campaign,” adds
Jennifer Levi, the director of transgender and queer rights at GLBTQ
Legal Advocates & Defenders, pointing to ways the report might show up
in future legal cases.

The HHS report—provocatively titled “Wolves in White Coats: How
Doctors and Hospitals Pushed and Profited from the Fraud of
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Medicine
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doctors’ use of two diagnostic codes when prescribing puberty
blockers. One of them, “precocious puberty,” is generally used to
describe early-onset puberty; the report argues that it’s improper
to use the same code for children delaying puberty while they take
time to explore their gender identity. The other, “endocrine
disorder, unspecified,” has been openly
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for years
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by some transgender healthcare providers as a way to avoid
stigmatizing or using pathologizing language like “transsexualism”
or “gender identity disorder.” According to a 2021 journal article
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“endocrine disorder, unspecified” code is “often used to bill
for transgender services to avoid the stigma of labeling the person
as transgender, because no [gender identity disorder] is present,
and/or to avoid denials of payment.”

The report frames these billing practices as a kind of fraud. And
while this theory hasn’t been fully tested in the courts, two recent
settlements indicate it could be a successful angle of attack in the
administration’s broader project
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to wipe out gender-affirming care for minors. Under pressure from the
Trump administration over such billing practices, at least two
hospitals—Texas Children’s Hospital
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and Cleveland Clinic
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to settlements this year. Tellingly, their settlement agreements
involved much more than adjusting their use of billing codes: Both
hospitals agreed to stop gender-affirming treatments for minors
entirely (though their states had already outlawed such treatments).
They also agreed to set aside money to treat people who detransition.
(Despite the heavy emphasis
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on a small handful of detransition stories by activists who oppose all
gender transitions, years of research have found regret rates of
around 1 percent among adult
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of gender-affirming surgery, and though there’s less research on
pediatric patients, the existing studies likewise
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indicate
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low regret rates.)

Though it bears the imprimatur of the federal government, much of the
“Wolves in White Coats” report contains material recycled from
conservative policy groups like the Manhattan Institute and anti-trans
activist groups like Do No Harm
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Five of its 10 authors—including former White House senior policy
strategist May Mailman, a close ally of Stephen Miller and the
architect of the Trump administration’s gender-related executive
orders
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employees of the Independent Women’s Forum, a faux-feminist
conservative advocacy group often behind anti-trans messaging
strategy. Another is Quentin Van Meter, past president of an
old-school religious-right group of doctors that hold anti-LGBTQ
positions
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and call themselves, misleadingly, the American College of
Pediatricians. Also on the author list is Eithan Haim, a Texas doctor
who previously faced federal charges for allegedly obtaining and
leaking the private information of patients who weren’t under his
care. (Once Trump took office, DOJ prosecutors dropped the charges
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against Haim.)

The actions of one author, Center for Christian Virtue president Aaron
Baer—whose group advocates “for public policy that reflects the
truth of the Gospel”—immediately suggested that the report could
provide political ammunition in the midterms. Shortly after its
publication, Baer took to X to demand
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Democratic gubernatorial candidate Amy Acton and her running mate
David Pepper comment on the Ohio healthcare providers flagged in the
report. (Baer’s group might see Acton as a soft target, after she
made a statement
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last month that misgendered trans girls as “boys” while saying she
supported restrictions on their sports participation.)

But beyond its political utility, this report could turn out to be
significant building block for the Trump administration’s
multi-pronged legal attacks
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on providers of gender-affirming care. Despite Vance making a grand
gesture on Thursday of referring providers for DOJ investigation, the
department has _already_ been investigating whether hospitals violated
federal law by promoting off-label use of puberty blockers and
hormones or by improperly billing the medications. As part of those
investigations, the federal government has issued sweeping subpoenas
for the private information of transgender children and teens
receiving gender-affirming care.

The problem for the Trump administration is that federal judges have
blocked these subpoenas almost
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universally. Last fall in Massachusetts, for example, federal district
judge Myong Joun quashed
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a DOJ subpoena to Boston Children’s Hospital for the medical records
and personal information—including home addresses and social
security numbers—of all patients who have received gender-affirming
care as well as the personnel files of over a thousand employees.

“It is abundantly clear that the true purpose of issuing the
subpoena is to interfere with the Commonwealth of Massachusetts’
right to protect [gender-affirming care] within its borders, to harass
and intimidate BCH to stop providing such care, and to dissuade
patients from seeking such care,” Joun wrote
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in his order. “The Government seeks all this while not offering an
iota of suspicion that BCH is actually engaging in fraudulent billing
practices or off-label promotion in the first instance.”

The report issued Thursday appears designed to provide that missing
“iota of suspicion”—potentially to allow the Trump
administration to overcome the roadblocks it’s been hitting in
court. “I think that’s DOJ’s plan,” says Levi, who has been
involved in efforts to fight the subpoenas.

The report also calls on private attorneys to join the Trump
administration’s efforts, urging them to file lawsuits accusing
gender-affirming care providers of billing fraud, and raising the
possibility of cash payouts to those who do.

Over half of states have outlawed gender-affirming medical care for
minors in recent years, following a coordinated campaign
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by right-wing and anti-LGTBQ activists. But care remains legal in many
states, some of which have passed laws protecting doctors.

* Health Care; Gender and Sexuality; LGBTQ;
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