As lawmakers vote on reducing Medicaid fraud, two whistleblowers on Capitol Hill this week spotlighted a children’s hospital that it claims is falsely billing insurance companies, including Medicaid, for transgender drugs for children. 

Surgeon Eithan Haim and pediatric nurse Vanessa Sivadge testified to the House Judiciary Committee on Wednesday that they witnessed doctors intentionally using incorrect diagnostic codes in order to ensure bills were covered by insurance companies. 

“I saw this with my own eyes. They were, for example, labeling a male with a testosterone deficiency in order to administer testosterone, and they would do this because on the medical chart they would put the preferred gender identity of the patient and not the biological sex,” Ms. Sivadge told committee members. “This makes it very difficult to detect fraud for any insurance company who gets the billing code.”

Dr. Haim said he suspects that this type of fraud is widespread. Texas Representative Brandon Gill pointed to a fact sheet by the Campaign for Southern Equality that seeks to help providers identify insurance codes for transgender health care that won’t be rejected.

“What this document does is inform doctors at these clinics how to get insurance companies, whether they’re private or government, to cover interventions without revealing that it’s being used for gender dysphoria,” Dr. Haim said.

Dr. Haim, who was a surgeon at Texas Children’s Hospital in 2023, says the hospital did not shutter its transgender surgery program despite claiming it would in order not to expose itself to potential criminal legal ramifications. 

He took his story to a journalist after not hearing back from Texas Attorney General Ken Paxton days before a state law was passed banning transgender medical interventions on minors.  A month later, he was prosecuted by the Biden administration’s Justice Department for allegedly violating patient confidentiality rules. The case was dropped by the Trump administration. 

“I decided to blow the whistle because as a doctor I had a legal and moral obligation to do so — the hospital I was working at was lying about a  program that was turning healthy children into chronic medical patients,” Dr. Haim said.

On his first day in office, President Trump signed an executive order recognizing only two sexes. The order also banned any federal funding for gender-affirming care and ordered that federal funding be revoked from any health care institution that provides gender-affirming care to anyone under 19. 

Last fall, Mr. Paxton sued at least three doctors of falsifying medical billing records for transgender medications, claiming one doctor, May Lay, falsely represented “that she’s treating patients for an unspecified endocrine disorder, when in fact she is transitioning their biological sex or affirming their belief that their gender identity is inconsistent with their biological sex.” Dr. Lau in January reached agreement with the state to  give up her medical practice and work in a research or academic setting only.

Representative Bob Onder of Missouri, who serves on the judiciary panel, has introduced legislation in Congress that would protect parents who “refuse to consent to chemical castration and mutilation of their child.” The No Harm Act would also protect medical care providers who refuse to perform such treatments and prohibits federal funding for transgender surgeries. 

An immunologist, Dr. Onder suggested that attempts to diagnose patients with hormone deficiencies instead of gender dysphoria is tantamount to malpractice.

“I have treated children for 30 years in my practice, not endocrinology but in a field where I saw a lot of kids. I don’t think I ever saw a kid with ‘precocious puberty’ on his or her chart,” he said.