McClain, Sessions Probe Fraudulent Medicaid Billing for Gender Transition Care

WASHINGTON—House Committee on Oversight and Accountability Subcommittee on Government Operations and the Federal Workforce Chairman Pete Sessions (R-Texas) and Subcommittee on Health Care and Financial Services Chairwoman Lisa McClain (R-Mich.) are today opening a probe into allegations of fraudulent billing of pediatric gender transition care by medical providers to Medicaid programs. In a letter to the Centers for Medicare and Medicaid Services (CMS), the lawmakers request documents and communications related to fraudulent Medicaid billing for gender transition care. Additionally, in a letter to the U.S. Department of Health and Human Services Inspector General (HHS OIG), the lawmakers request a staff-level briefing to address Medicaid program integrity.

“The Committee on Oversight and Accountability is investigating allegations of Medicaid fraud involving irreversible gender transition care for minors. According to whistleblower allegations, medical providers in at least the state of Texas, specifically Texas Children’s Hospital (TCH), are fraudulently billing Medicaid for pediatric gender transition care in violation of state law and state Medicaid policies. We are concerned that the Biden Administration is targeting individuals who expose unlawful practices while turning a blind eye to underlying Medicaid fraud,” the lawmakers wrote.

Oversight Committee Republicans have been conducting oversight of waste, fraud, and abuse in the Medicaid program by reviewing program integrity and identify weaknesses in the program. Despite the Government Accountability Office (GAO) producing multiple reports identifying weaknesses in the processes Medicaid agencies use to identify improper payments and fraud, CMS and HHSOIG have failed to take necessary action.

“Under Texas Medicaid, all gender transition care was ineligible for Medicaid coverage at the time of these allegations. We are concerned that medical providers at TCH are falsifying diagnosis codes for patients seeking gender transition care to obtain Medicaid approval and payment for noncovered services. For example, we understand a TCH provider seeking to ensure Medicaid coverage of gender transition care appears to have fraudulently diagnosed a biologically female patient with testosterone deficiency and hypogonadism in order to obtain Medicaid approval for testosterone treatment that would otherwise be denied under Texas Medicaid regulations if prescribed for the purpose of gender transition,” the lawmakers continued.

Read the letter to CMS Administrator Chiquita Brooks-LaSure here.

Read the letter to U.S. Department of Health and Human Services Inspector General Christi A. Grimm here.