The U.S. Department of Health and Human Services (HHS) has released a report titled “Wolves in White Coats,” which states that over 225 hospitals and health systems have pushed gender dysphoria diagnoses on children, misusing billing codes to fraudulently bill private insurers and Medicaid for treatments including puberty blockers, cross-sex hormones, and surgeries.

According to the report, between 2015 and 2025, approximately $50 million in insurance claims were filed using the endocrine disorder diagnostic code E34.9 — a code not intended for gender-related conditions — for patients receiving puberty blockers. The report notes that this misclassification violates federal guidelines because gender dysphoria is not an endocrine disorder.

Vice President JD Vance today referred hundreds of hospitals and clinics identified in the report to the Department of Justice and HHS Inspector General for possible violations of federal law. In a letter to Attorney General Todd Blanche, Vance stated that healthcare providers intentionally misdiagnosed children with endocrine disorders to secure insurance coverage for gender-transitioning interventions.

The report cites peer-reviewed scientific literature, hospital records, whistleblower testimony, and interviews with patients and parents. It details how some hospitals have used misleading billing codes to ensure long-term financial benefits from children who undergo experimental procedures that can result in lifetime medical costs of up to $170,000 per patient.

Vance emphasized that when providers intentionally miscode treatments to obtain insurance coverage for gender-transitioning interventions that would otherwise be denied, they should face criminal prosecution. The report found a 30 percent increase in endocrine disorder diagnoses among minors without a corresponding rise in actual pediatric endocrine disorders, suggesting potential fraud.

The HHS report also notes that children subjected to these procedures have often been turned into “captive patients” for life, with the average healthcare cost for a minor rising from $3,000 to as much as $170,000 without surgery and nearly $250,000 with surgical interventions.

Vice President Vance was joined by HHS Secretary RFK Jr. in discussing the report’s findings on social media.