Yesterday the Department of Health and Human Services released a report, Wolves in White Coats. Along with surgeon and whistleblower Dr. Eithan Haim, I drafted the first two chapters of the report, and my colleague Rachel Morrison at EPPC drafted the third chapter. The report describe how hospitals and clinics recklessly embraced sex-rejecting procedures on minors, despite the lack of evidence of safety and efficacy for these interventions. Our research on insurance claims, presented in Chapter 2, highlights widespread false billing practices that could implicate these institutions in criminal fraud under the False Claims Act. In short, doctors lied about patients’ diagnoses to ensure insurance reimbursements from public and private payers, and in some cases, to circumvent state laws that prohibited these procedures on minors.
The full report and a shorter executive summary are available here. For those who want a brief, high-level overview, I recommend this 12-minute film released in conjunction with the report. The testimonies here from adolescents who were irreversibly harmed by these procedures are particularly devastating:
Here’s Vice-President JD Vance, HHS Secretary Robert F. Kennedy Jr., and HHS Assistant Secretary for Health Brian Christine presenting the report to the public yesterday and explaining the actions they will take in response to it:
Vance has already referred the matter to the DOJ for investigation into potential criminal fraud. You can find his letter posted here:
HHS Secretary Robert Kennedy Jr. has separately sent a letter to HHS Inspector General Thomas March Bell that includes a list of specific hospitals and clinicians Kennedy says should be investigated for potential crimes. The report also calls for additional review of insurance coding practices that enabled the alleged fraud.
In conjunction with our report, the White House announced that Medicaid will no longer fund sex rejecting procedures for minors:
I’m pleased to see that the report is already having an impact on public policy and drawing attention to this issue in the media. My hope is that it will help put an end to these harmful practices, which were never justified by sound medical science, but instead pushed for financial and ideological reasons, as the report documents in detail.
I was going to close this post with a my own commentary on the implications of this report, when I ran across this long post on X by an anonymous account from a man who calls himself “Boris Spider”. His bio indicates he’s a father whose child was caught up in the machinery of sex-rejecting procedures, and he clearly has a strong legal background. I will share with you his commentary on what happens next, since it’s the most incisive I’ve seen yet on the implications of the report:
I think the Wolves in White Coats report is possibly one of the most significant successes in the effort to roll back gender medicine. It may have longer lasting impacts than almost any other action the administration has taken. Sorry for the long post. It doesn’t make sense to break this into a thread and all of this really needs to be said. In any event, please take the time to read this.
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You’re a parent with an adolescent who has suddenly started ruminating over gender. You get “the letter” explaining they have finally expressed their true selves, demanding you no longer refer to them as the name you gave them as an infant. You live in a state where pediatric gender procedures have not been banned, maybe they’re actually promoted by your schools, public health agencies, etc. You’ve been rushed into the question of consenting to hormones and puberty blockers for your kid and reluctantly arrive at the doctor’s office for the first visit. You have a pit in your stomach knowing that you should walk out but every – EVERY – person in a position of authority is pushing you to this.
You arrive at the hospital where the gender clinic is. It’s the most prestigious children’s hospital in your city. You walk into the immaculate lobby, past a bunch of bright, modern art work, through a spacious, brightly lit atrium. This place is the best of the best. They treat rare cancers, horrible childhood diseases. You recall they saved the life of one of your neighbor’s kids. This is reassuring. You start to feel better about what is coming – they won’t do anything that would hurt your child. The doctor you are seeing is an “expert” on gender issues. She has a faculty position at the med school that’s affiliated with this hospital. You are surrounded by authority, expertise, reassurance. Whatever they say will probably be correct.
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With the release of the Wolves in White Coats report this morning, the days remaining for this whole façade became marked. In the next few months, possibly weeks, you are going to see that carefully cultivated and maintained illusion of authority come crashing down. The chain of events about to unfold is going to be multifaceted and complex, but the simple explanation is that there is no defense to a claim of intentional billing fraud.
Here’s what’s going to happen:
- A list of over two hundred institutions is being given to the DOJ to investigate for billing fraud. The report lays out the road map to investigate these claims, the probable cause, the legal theory. DOJ has already had three successes (Texas, Ohio, and Connecticut), but they were paving the road behind them in these cases. Texas was a partnership with the Texas Attorney General, who more than likely was educating them on the legal strategy. They were able to quickly reach settlements in Ohio and Connecticut after that “training” (man I hope nobody at the DOJ sees this and thinks I’m talking smack about them. I’m not, I’m just reading the tea leaves.)
Now they have the play book and some experience. They can train local US Attorneys and their staff in field offices around the country. Things are going to move quick. More importantly, they have both backing and expectations pushing this. This report went through not only JD Vance’s office – but Stephen Miller and that guy is scary. Nobody wants to get the call that Stephen Miller thinks you are not taking one of his priorities seriously.
- The Office of Inspector General at the Centers for Medicaid and Medicare (CMS OIG) is about to get involved. As I, and others, have been posting and screaming for over a year THEY CAN AUDIT ANY PROVIDER FOR ALMOST ANY REASON. Once they identify a practice area or industry that is a high risk for fraud then can move in, audit their bills, refer cases to DOJ, disbar providers from ever participating in government programs again, and force civil settlements of their own as long as it does not involve violations of the Federal False Claims Act. But, because these cases do involve this statute, CMS will be acting as a referral agency to the DOJ - not settling cases itself. Major, major headache for the bad guys.
- This is going to make life very uncomfortable for some important people – the risk managers, board members, and general counsel of the hospitals where the nations most prestigious gender clinics sit. They get audited by CMS all the time, and they regularly pay money, but those are “administrative actions.” They involve “mistakes” not fraud. There is no risk of jail or severe civil penalties. The Federal False Claims Act involves real risk. Some of these GC’s may have thought they were only facing a risk of administrative actions. That misconception was cleared up today.
These general counsels are going to quickly learn their position sucks – they have no defense for the fraud that their blue haired queer communist doctors and coding staff have been committing in the name of Protecting Trans Kids. That’s why the Ohio and Connecticut hospitals settled so quickly.
Several hospitals (Boston Childrens’, NY Langone, UPMC – Pittsburg) have contested records requests from DOJ. But they don’t have the power to fight a CMS audit. These hospitals in particular are at risk because they have pissed off the DOJ – and the DOJ is definitely going to be swinging back around with a fat file the CMS OIG dumped on their desk. The Trump Administration probably doesn’t want to be in the business of bringing criminal charges against childrens’ hospitals, but in a few months they will have the leverage to do that and that means they can set the terms of these settlements.
- As a result, gender medicine is now going to be associated with yet another “negative externality” in the minds of the fiduciaries for these institutions – criminal billing fraud. Add it to the list: poor outcomes, public controversy, doctors with CSA materials on their hard drives. The liberal elites have been looking the other way for a long time, but now they can’t argue “The Science,” or “Protect Trans Kids,” or any of the slogans because THERE IS NO DEFENSE ONCE IT IS ESTABLISHED THAT THEY BILLING CODES WERE INTENTIONALLY CHOSEN. They are going to be hit in the pocketbook on charges that they cannot defend and they will be both humiliated and punished.That shit always rolls downhill in an organization. There will be scapegoats.
- The gender doctors have, so far, been protected by their institutions, their medical associations, their licensing authorities. They are about to lose one of those benefactors and the other two will not be able to save them from federal charges for violating the False Claims Act.
Their hospitals will be heavily incentivized to leave them exposed. DOJ policies strongly encourage organizations to roll over on individual defendants. Fair or unfair, these docs are about to find be treated like the CFO of Enron 25 years ago – left high and dry while their employer cuts a deal for a monetary penalty. An added fact is that doctors and hospitals bill SEPARATELY. They are each liable for their own bills. The hospitals have no incentive to protect doctors who committed fraud. (On the other hand, doctors have no incentive to protect hospitals, and we may get testimony from doctors saying the hospitals encouraged this. Who knows?)
Their state licensing authorities can allow the docs to keep their licenses, but if you’re not a cosmetic surgeon it’s almost impossible to make a living as a doctor if you are shut out of government programs and that is exactly the power the DOJ has even if they don’t put the docs in jail. Disbarment from Medicare and Medicaid.
While not every doctor is going to face jail or disbarment, I think after DOJ/CMS dig into this and find the really bad actors they are going to take some scalps as an example. (Note the doctors at Texas Childrens were NOT part of that settlement. They are still exposed to being permanently disbarred from Medicare/Medicaid nationwide and possibly jail.)
The docs who remain will no longer be practicing at the elite teaching hospitals. They will be practicing in medical office buildings, maybe strip malls. No fancy atrium. No teaching position at the local med school. Far less prestigious.
Sure, you go see your primary care doc in a building like that, but he’s not (usually) making life and death decisions. The whole thing seems a lot less certain. A lot less…authoritative. The parents will have a lot less reason to say yes and more reason to say “let’s talk about this.”
I think that is the world we started creating today.
I sincerely hope that he is right about this. Stay tuned to Human Flourishing for more updates.
Thank you for protecting our children. The wolves in white coats who butchered their patients must be prosecuted. They are Mengeles that committed crimes against humanity.
Excellent and much needed work. Bravo, Aaron & team!