The federal government is accusing children's hospitals and health care providers, including several in Ohio, of millions of dollars in insurance fraud by pushing transgender youth care services on patients to line their own pockets.
However, industry experts have refuted such accusations, pushing back on the idea that gender-affirming care is a "cash cow" for hospitals and that patients and families are being cajoled into receiving such care.
The U.S. Department of Health and Human Services report, which conservative Ohio lobbying organization Center for Christian Virtue contributed heavily to, says there is evidence of roughly $60 million in total insurance fraud by medical professionals nationwide between 2015 and 2025 across hundreds of hospitals.
The possible fraud, they say, came from physicians sending incorrect diagnostic codes to help children receive gender-affirming care to profit from that treatment.
Nationwide Children's Hospital in Columbus, Cincinnati Children's, Akron Children's Hospital and Dayton Children's Hospital are all named in the report as possible culprits in the alleged fraud.
Nanette Bentley, a spokesperson for Cincinnati Children's, said in an email that they were reading the report but declined to comment further. Nationwide Children's and the other Ohio hospitals listed did not respond to requests seeking comment.
Vice President JD Vance took to social media Aug. 13 to praise "Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of 'Gender Medicine'," saying in a video post on X that "it turns out that convincing vulnerable children to reject their gender can create patients for life, earning hospitals tens of thousands of dollars in additional revenue per child."
However, the report itself stipulates that its own foundational data is limited, and further investigation is required to prove the allegations.
What exactly are hospitals being accused of?
The claim at the heart of the report is that doctors are pushing gender-affirming care on minors and their families to make money. The providers allegedly do this by first convincing the patient they need this care, and then to make sure they profit, they bill insurance companies under codes that are more likely to be reimbursed to the hospital.
Knowingly, intentionally and consistently using the wrong diagnostic code, a code that tells an insurance company what a patient has been diagnosed with, is a form of medical insurance fraud under the False Claims Act.
The report notes cases where hospitals and providers billed for puberty blockers for children diagnosed only with a nonspecific endocrine disorder, without including further diagnoses related to gender identity or an early start to puberty − the "typical" reasons for such prescriptions.
Endocrine disorders are usually due to an imbalance of hormones, and the nonspecific code is often used as a placeholder until a more specific diagnosis can be made.
Dayton and Cincinnati Children’s hospitals were also listed in the claims that they improperly billed for puberty blockers given to patients who started puberty early but were ages 13 to 17 at the time of the prescription. On average, puberty starts between the ages of 8 and 14, according to Cleveland Clinic, but the diagnostic code can be used from birth to 17 years old.
The insurance claims data, in compliance with health privacy law, do not contain personal, identifying information of individual patients. To investigate the claims further, there would need to be criminal investigations in which protected health information could be subpoenaed by a court. Until then, the data used in the report, even including diagnostic codes and age, can't confirm that all the children treated under those codes are transgender.
"It's not definitive proof, but it's a huge blaring red flag," said Dr. Aaron Kheriaty, a physician and contributor to the report. He added that report contributors could not find "any other plausible explanation for why that intervention would be done and why that particular drug would be given to people over the age of 12."
Accusations were also made against multiple Planned Parenthood locations in Ohio. Planned Parenthood Southwest Ohio Region is accused of submitting insurance claims for hormone replacement therapy for minors the same day they were diagnosed with gender dysphoria. The regional provider denied this and said in an email that their offices do not provide gender affirming care to minors.
A provider associated with Planned Parenthood of Greater Ohio allegedly gave a minor a prescription for hormones, according to the report. Lauren Blauvelt, chief external affairs officer at Planned Parenthood of Greater Ohio, said in an emailed statement that "this inquiry is a false political attack designed to intimidate providers and distract from the real health care crisis facing Ohioans and all Americans."
Is gender-affirming care really making hospitals money?
The report estimates that 225 medical institutions and providers fraudulently billed public and private insurance companies for roughly $60 million for puberty blocker prescriptions between 2015 to 2025 in order to make money.
The average annual cost of gender-affirming care is a little over $1,000 per capita, accordingto The National LGBTQ+ Healthcare Alliance. By comparison, KFF estimates that health care spending per capita was more than $15,000 in the U.S. in 2024.
During testimony against Ohio's transgender care ban in May 2023, Dr. Patty Manning-Courtney, a developmental pediatrician at Cincinnati Children's, said gender-affirming care does not provide a financial incentive.
"Multidisciplinary care of children and adolescents with gender dysphoria requires substantial financial resources, particularly mental health care, for which reimbursement is abysmal," Manning-Courtney said in her testimony.
In the large scheme of health care costs, gender-affirming care is a drop in the bucket.
For example, Nationwide Children's in Columbus collected more than $4 billion in revenue in 2025, according to ProPublica's Nonprofit Explorer. Cincinnati Children's collected more than $3.5 billion in revenue in 2025, which is roughly 58 times more than the total amount of fraud claims for the listed institutions over the course of a decade.
The report alleges providers are moved by their own beliefs and financial incentives to provide gender-affirming services, saying the surgical procedures associated with gender-affirming care keep cash coming in.
Genital reconstruction surgeries that change a person's external sex organs costaround $25,000, according to Forbes.
In comparison, a gallbladder removal procedure can cost roughly $45,000, according to Cincinnati Children's online cost estimator.
A New York University study from 2019 estimated that between 3% to 15% of transgender people undergo bottom surgery. In children, such procedures are rare, performed only in extreme circumstances when extensive criteria are met.
Ohio's transgender care ban went into effect in April 2024. Children who had started hormone therapies before the ban began were allowed to continue care under certain conditions, but medical professionals have maintained that genital reconstruction surgeries were not being performed on minors in Ohio since the ban first was brought to the legislature.
Doctor says study oversimplifies a complex issue
Dr. Chris Bolling, a retired pediatrician from Cincinnati, said gender-affirming care for children is more nuanced than diagnostic codes.
The language in the report, he said, oversimplifies care and erases intersex people, or people born with sex traits including hormones or sex organs that don't fit binary female and male patterns, to back up these allegations of fraud.
"They want it to be very, very simple, and that's just not true," Bolling said.
There still is much to be studied about gender-affirming care and the impact gender dysphoria may have on the endocrine system. Each case requires a personal, individual approach between doctor and patient families, he emphasized.
"If you're concerned about it, give guidance," Bolling said of the report's authors. "But the bottom line is, they feel like they know how these kids should be treated... in their mind [being transgender] doesn't really exist."
The American Academy for Pediatrics (AAP) told The Dispatch via email that it did not plan to put out a statement on the report as of Aug. 14.
In February, the AAP filed a lawsuit challenging a federal investigation into its guidance on caring for transgender children, calling it "unconstitutionally retaliatory." The AAP has repeatedly broken from the Trump administration on health guidance, including childhood vaccinations and gender-affirming care.
Could legal action be next?
Vance and Health and Human Services Secretary Robert F. Kennedy Jr. reported the listed institutions to the Department of Justice and the Office of Inspector General for possible violations of federal law, according to an Aug. 13 press release.
In June, Cleveland Clinic settled a lawsuit with the Department of Justice after similar fraud investigations related to gender-affirming care for minors. The hospital committed $2 million in care for people who decide to detransition as part of the settlement.
The press release also calls for increased oversight of insurance billing practices and encourages further evaluation of practices related to gender-affirming care for youth.
Ohio's gender-affirming care ban is still in effect, even as the Trump administration backed down on a nationwide ban and lawsuits against the ban are ongoing. The state is awaiting a decision from the Ohio Supreme Court on the future of the ban.
Business and consumer issues reporter Samantha Hendrickson can be reached at shendrickson@dispatch.com
This article originally appeared on The Columbus Dispatch: HHS says Cincinnati providers fraudulently billed for transgender care
