Transgender care at CHOP faces investigation for alleged fraudulent billing practices, according to the Department of Justice.

The Trump administration is intensifying its legal scrutiny of children’s hospitals in Philadelphia and Pittsburgh, specifically targeting practices surrounding the treatment of transgender youth receiving gender-affirming medical care. Recent court documents filed by the U.S. Department of Justice assert the existence of evidence that suggests possible fraudulent billing practices by medical professionals at Children’s Hospital of Philadelphia (CHOP) and the Children’s Hospital of Pittsburgh, part of the University of Pittsburgh Medical Center (UPMC).

The investigation has focused on the possibility that doctors at these institutions may have misrepresented diagnoses to secure insurance reimbursements for off-label drug prescriptions intended for the treatment of gender dysphoria, a condition where an individual’s physical sex characteristics do not align with their gender identity. The DOJ’s claims are outlined in sworn statements submitted to federal district courts in Pennsylvania as part of a broader inquiry into potential violations of the Food, Drug, and Cosmetic Act.

Earlier this year, federal authorities issued subpoenas to examine private patient medical records from at least 20 hospitals across the United States, including CHOP and UPMC. CHOP’s Gender and Sexuality Development Program, launched in 2014, is among the largest clinics of its kind in the country, providing comprehensive medical care and mental health support to numerous families annually. Hospital officials have remained silent regarding the latest DOJ filings.

In response to the DOJ’s investigatory efforts, UPMC indicated that the accusations lack substantial evidence or specific allegations of wrongdoing. Amid the legal pressures stemming from the Trump administration’s policies, UPMC has decided to halt gender-affirming care for patients under the age of 19 and has not sought any legal remedy against the federal subpoena.

The DOJ’s filings highlight concerns centered on the off-label prescribing of puberty blockers and hormones, an established practice within pediatric medicine. While the American Academy of Pediatrics and other authoritative medical organizations endorse these treatments as safe and crucial for the mental well-being of minors, the Trump administration has categorized such prescriptions as a form of chemical mutilation, equating them to child abuse.

Nationally, the legal battle continues in various courts, as stakeholders seek to protect the privacy of medical records for former patients and parents of children who have undergone gender-affirming treatments. These parties assert that the DOJ’s actions signify a misguided attempt to criminalize lawful medical practices. The investigation is particularly focused on whether there is misuse of billing codes and diagnostic criteria related to conditions like central precocious puberty to justify gender-affirming treatments.

In a case pertinent to CHOP, the DOJ disclosed its engagement of government contractors to analyze extensive anonymized insurance claims submitted by healthcare providers, revealing that between 2017 and 2024, CHOP diagnosed over 250 minors aged ten or older with central precocious puberty. This age range raises concerns regarding the appropriateness of such diagnoses given typical medical standards.

As the DOJ continues its investigation, both hospitals are fighting to defend against what they describe as an overreach of governmental authority that threatens the confidentiality and quality of care provided to transgender youth. The unfolding legal drama underscores the intersection of healthcare, policy, and the rights of transgender individuals in the United States.

This investigation is unfolding amidst a complex legal landscape, with implications that extend into multiple ongoing cases challenging the legitimacy of government actions against healthcare providers involved in gender-affirming treatments for minors. As legal proceedings develop, the outcomes may significantly affect the landscape of transgender healthcare in the nation.