Legal
Federal Government Refers Hospitals, PBMs to DOJ Over Gender-Affirming Care Billing
The Vice President and HHS Secretary have referred dozens of hospitals, pharmacy benefit managers, and pharmacies to the Department of Justice and HHS Office of Inspector General for investigation of potentially fraudulent billing related to pediatric gender-affirming care. The referrals follow a new HHS report identifying organizations for scrutiny. The investigations will focus on billing practices for these services. This represents a significant enforcement action affecting hospitals and pharmacies providing or processing claims for pediatric gender-affirming treatment.
Why it mattersMedicaid managed care plans and state agencies overseeing these services face potential claims recoupment, contract compliance reviews, and heightened scrutiny of prior authorization and claims processing for gender-affirming care.
Also covered by:thehill.com