Spotting Potential Fraud: How Healthcare Providers May Skirt Coding Rules to Get Paid for Child Sex Changes

The rise of the child transgender industry over the past decade has relied, in no small part, on the financial incentives for physicians and hospitals to perform sex-denying medical interventions. These procedures offer a potentially lucrative revenue source.

But insurance coverage has been variable for medical procedures performed for the purpose of so-called “gender-affirming care” for minors. Further, dozens of states now restrict Medicaid funding for sex-denying interventions for minors or restrict minors’ access to the procedures themselves.

This report aims to show the avenues through which healthcare providers may be able to skirt official coding guidelines to secure insurance reimbursement for so-called “gender-affirming care.” By misrepresenting the medical procedures they are performing, providers can pass off transgender medicalization as, for example, routine endocrine care unrelated to pediatric medical transition. These “loopholes” may enable providers to get paid for procedures which otherwise may not be funded. In some cases, such practices may even be outright fraudulent or a means of evading state-level restrictions on child sex change interventions.

Continue reading the full report below.

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