250+ Health Care Entities Targeted by HHS, DOJ Over Gender-Affirming Care for Minors

On August 12, 2026, U.S. Department of Health and Human Services (“HHS”) Secretary Robert F. Kennedy Jr. sent a letter (“Referral Letter”) to HHS Inspector General T. March Bell, targeting more than 250 health care entities providing gender-affirming care to minors “for investigation into possible violation of federal statutes.”

The list originates from an HHS report (“Report”) made public on August 13, “Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of ‘Gender Medicine’”—purporting to identify “an objectively defined cohort of claims that exhibit potentially anomalous billing patterns, which justifies further scrutiny by the HHS OIG,” the Referral Letter states. The Report is focused on commercial and government insurance claims data from 2015 through 2025 and discusses hospital revenue incentives and diagnostic and procedural coding practices. It also includes a chapter with first-hand accounts from patients and parents impacted by gender-affirming care.

The seven-page Referral Letter names hospitals, health care systems and networks, specialty pharmacies and infusion services, medical clinics and practices, individual health care providers, university medical centers, and Planned Parenthood affiliates. Entities are sorted into various cohorts based on claims data: (1) puberty-blocker claims billed with an endocrine-disorder code alongside no gender-dysphoria or precocious puberty code; (2) puberty-blocker claims billed with a precocious-puberty code; (3) same-day gender-dysphoria and cross-sex-hormones claims in states where such prescriptions were legally restricted for minors; and (4) Planned Parenthood affiliates identified through prescriber billing affiliation matching rather than direct claims.

“Given the seriousness of these potential violations, HHS requests that HHS OIG swiftly evaluate this referral,” Kennedy concludes.  

DOJ: ‘Clear Message’

In a second letter circulated on X, dated August 13, Vice President J.D. Vance tasked Attorney General Todd Blanche and the U.S. Department of Justice (DOJ) with determining “whether the providers identified have violated federal law, regulations, or policies including, but not limited to, the Federal Food, Drug, and Cosmetic Act, the [civil] False Claims Act, 18 U.S.C. § 24, and federal fraud and conspiracy laws.” (“DOJ Letter”).

“When providers miscode treatment in order to secure insurance coverage for gender-transitioning interventions that insurance would not otherwise cover, they should be held accountable,” the DOJ Letter states. “If they have done so intentionally, thereby perpetrating a fraud on Medicaid or on private insurers, they should go to prison. Rather than allow the proliferation of harmful, sex-rejecting procedures on our children, we must send a clear message that any hospitals and providers that have participated in these practices will face justice.”

The letters come just after CMS announced, on August 11, that federal Medicaid and the Children’s Health Insurance Program (“CHIP”) will end taxpayer-funded “child sex-change” procedures including hormone therapy and surgeries. The announcement was accompanied by a Final Rule scheduled to go into effect on October 13. Additionally, during a press conference on July 21, 2026, Secretary Kennedy announced a significant expansion of CMS’s authority to now include exclusion of health care providers, a power previously only reserved to OIG (see EBG blog post here). 

Takeaways

The administration’s multi-agency strategy to combat gender-affirming care—what it generally refers to as “sex-trait modification procedures” or “sex-rejecting procedures”—continues to escalate. We will have more in an upcoming client Insight. In the meantime, those operating in the gender-affirming care space should continue to focus on rigorous compliance with all potentially applicable federal and state laws including those outlined above and continue to seek the advice of counsel. In particular hospitals, health care systems and networks, specialty pharmacies and infusion services, medical clinics and practices, individual health care providers, university medical centers, and Planned Parenthood affiliates should review the Referral Letter and seek counsel to evaluate their potential legal exposure and collateral issues. 

EBG’s “Gender-Affirming Care: What Health Care Providers Need to Know About Federal Enforcement” Video Series provides first step analysis and takeaways:

Coordinated Enforcement Tools

The federal government is employing executive orders, civil and criminal investigations, notice-and-comment rulemaking, agency enforcement actions, and public pressure campaigns to limit gender-affirming care. Providers may face challenges from multiple federal agencies and branches at once.

Judicial Scrutiny of Agency Motives

Courts are examining whether agency enforcement actions are grounded in legitimate regulatory authority or motivated by political objectives.

Multi-Forum Defense Strategies

Health care providers defending against coordinated federal enforcement are engaging across multiple agencies and courts rather than pursuing a single legal strategy or forum.

Collaborative Response Efforts

Health care organizations are coordinating with peer organizations and state attorneys general in response to federal enforcement efforts.

If Investigated: Our Gender Affirming Care Working Group works with clients, conducting both internal investigations and responding to enforcement actions. If you have questions, please reach out to the authors.

Epstein Becker Green Staff Attorney Ann W. Parks contributed to the preparation of this post.

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If you have questions, please reach out to the author(s).

The Health Law Advisor blog is currently edited by Emily Chi Fogler.