Boston Children’s Hospital Could Be Illegally Tricking Insurers Into Covering Sex Changes, DOJ Suggests

The Boston’s Children’s Hospital (BCH) may be using fraudulent billing codes to ensure minors receive insurance coverage for puberty blockers, federal prosecutors suggested in a court document filed Tuesday.

The hospital has diagnosed hundreds of children with central precocious puberty (CPP) for the first time at ages 10 or older since 2015, even though 10 years old is a “normal” age for puberty, according to anonymized insurance data analyzed by the government.

The “large scale of these late diagnoses raises suspicion that BCH incorrectly diagnosed certain children with CPP in order to mislead insurance companies or others into covering puberty blockers for older children with gender dysphoria,” the government wrote in a court filing. “Misleading insurance companies or others about a patient’s diagnosis in order to obtain payment for off-label pharmaceuticals could form the basis of a federal 🏥Healthcare offense,” the filing states.

Precocious puberty describes sexual development that happens before age eight for girls and before age nine for boys, BCH’s own website states.

“One would thus expect relatively few patients diagnosed with precocious puberty at age 10. A significant increase in diagnoses among older age groups would certainly raise eyebrows,” Dr. Kurt Miceli, Medical Director of Do No Harm, told the Daily Caller News Foundation.

Boston Children’s Hospital and the Department of Justice (DOJ) did not respond to a request for comment.

DOJ graph showing insurance data on central precocious puberty diagnoses at BCH. The x-axis represents the year of first diagnosis, the y-axis the number of patients and the graph line colors the patient’s age at first diagnosis, according to the court filing. E301 refers to the diagnosis code for precocious puberty. (Credit: Department of Justice/ Screenshot)

The data reveals a “large spike” in “facially suspect diagnoses” of precocious puberty from 2020 to 2023, with at least one patient diagnosed at age 22. BCH defines delayed puberty as not undergoing sexual development by age 13 in girls and age 14 in boys. It treats the condition with hormone therapy, not puberty blockers, to get puberty “jump-started,” according to BCH’s website.

There is “no clear explanation for why BCH would go from diagnosing almost no 11-year-olds with CPP for the years 2017-19 to diagnosing 50 11-year-old patients with CPP in 2022,” the government argued.

Puberty blocking drugs, which can cost thousands of dollars, are approved by the Federal Drug Administration (FDA) for the the treatment of precocious puberty but not for the treatment of gender dysphoria.

The federal government is aware of “evidence of fraudulent billing practices to secure insurance coverage/payment” for child sex change medical interventions “because they know that certain insurance plans may not cover the off-label prescription of puberty blockers or cross-sex hormones for gender-related treatment,” Lisa Hsiao, acting director of the DOJ’s Enforcement & Affirmative Litigation Branch, stated in an affidavit filed Tuesday.

The newly released data was included in the government’s motion for a judge to alter his order blocking enforcement of their subpoena in September. The DOJ announced in July that it had issued more than 20 subpoenas to doctors and clinics that offer transgender procedures to minors.

Judge Myong Joun, a Biden appointee, claimed the government was operating in “bad faith” and had not offered “an iota of suspicion that BCH is actually engaging in fraudulent billing practices or off-label promotion in the first instance.”

Joun wrote that the government’s “true purpose” was to interfere with the state’s “right to protect GAC ,” objecting to its requests for “an astonishingly broad array of documents and information that are virtually unlimited in scope,” including “the personnel files of nearly all 2,000 individuals” who work for the hospital.

“Massachusetts does not ban GAC,” Joun wrote. “And there exists a diagnosis code for GAC for billing purposes. It is thus difficult to understand what exactly the Government is trying to investigate BCH for.”

One of the clinic’s LGBT researchers, Dr. Jeremi Carswell, said during a 2020 conference that puberty blockers were being handed out “like candy,” according to the government’s filing.

BCH, America’s first pediatric gender clinic, was reimbursed $1.4 million by the state of Massachusetts for its “gender transition services” from January 2015 to May 2023, according to a public records request submitted by the DCNF.

BCH attempted in July to shield filings in its effort to fight the subpoena from public view but the judge denied its request to seal the docket.

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