Dr. Eithan Haim, the surgeon who exposed Texas Children’s Hospital’s secretive transgender procedures on minors, warned lawmakers during a Wednesday hearing about a trend involving health-care providers fraudulently billing insurance companies for gender transition surgeries.
During the house Judiciary Committee hearing, Representative Brandon Gill (R., Texas) asked Haim about a fact sheet from the Campaign for Southern Equality, an LGBTQ nonprofit, instructing medical providers on which insurance codes to use for diagnoses and treatments related to what activists call “gender affirming care.”
The document identifies the ICD-10 insurance code corresponding with gender dysphoria or, more broadly, gender identity disorders as an example that insurance companies commonly reject. It lists numerous alternative codes that are commonly accepted, which Haim explained are used to allow transgender procedures to fly under the radar of insurance providers.
“What this document does is inform doctors at these clinics how to get insurance companies, whether private or government, to cover interventions without revealing that it’s being used for gender dysphoria,” Haim testified before the House Judiciary Committee’s Subcommittee on the Constitution and Limited Government.
The general surgeon then said if a physician wants to perform a mastectomy on a girl and “not raise any red flags,” they could label it a breast reduction surgery. A mastectomy fully removes, rather than reduces, breast tissue.
Or if a physician prescribes testosterone to a girl through hormone therapy, they could say they’re diagnosing testosterone deficiency for a male patient.
Insurance companies “don’t know that they’re getting defrauded,” Haim told lawmakers. “This guide is essentially a template for how to commit medical fraud. We should all remember that this is something that people go to prison for. This is a major deal. They have entire departments and hospitals for this.”
A former nurse at Texas Children’s Hospital, Vanessa Sivadge uncovered evidence of Medicaid fraud at the Houston-based medical facility. She accused the hospital of using Texas Medicaid to finance cross-sex hormones and puberty blockers for minors. After coming forward, she was fired by the pediatric hospital.
Sivadge testified on Capitol Hill alongside Haim, explaining how she “noticed discrepancies in the paperwork” at her workplace.
“My job consisted of refilling medications and obtaining insurance approval for those medications. I discovered how Medicaid was being billed for transgender interventions in direct violation of Texas law,” she said in her opening statement. “I also observed how TCH had misdiagnosed patients for the purpose of justifying those treatments. Additionally, the hospital had changed medical records by listing the preferred gender identity on the medical record instead of the birth sex, making fraudulent billing difficult to detect.”
Haim believes medical fraud is being used to conceal transgender procedures in red states, like Texas, where insurance companies may be more wary of high-risk treatments.
Last year, Texas Attorney General Ken Paxton sued at least three doctors who misrepresented diagnoses and sexes by falsifying medical and billing records to hide prescriptions for “gender affirming” medications, in violation of state law.
In one of the lawsuits, pediatrician May Lau allegedly used a diagnostic code pertaining to endocrine disorders to bill the insurance company for a "puberty blocker device" for a 15-year-old patient. Lau had used the billing code, the suit alleges, to "falsely represent that she's treating patients for an unspecified endocrine disorder, when in fact she is transitioning their biological sex or affirming their belief that their gender identity is inconsistent with their biological sex."
In January, Lau entered an agreement with Paxton preventing her from practicing medicine on patients entirely and relegating her work to a research, administrative, or academic setting.
Texas bans minors from accessing puberty blockers, hormones, and gender transition surgeries through S.B. 14. That law was passed by the Texas legislature in 2023, days after Haim blew the whistle about Texas Children’s Hospital. The legislation was upheld by the state supreme court last year.
Shortly after taking office this year, President Donald Trump signed an executive order prohibiting medical institutions from performing gender reassignment surgeries on children. If they are caught engaging in those practices, the order authorizes the withholding of federal funds from those institutions.
Haim was prosecuted by the Biden Justice Department for leaking documents to a journalist in an effort to expose the fact that Texas Children’s Hospital continued performing transgender procedures on minors after publicly stating otherwise. Haim was charged with violating patient confidentiality, though none of the records he leaked contained individualized patient information. The charges were ultimately dropped after President Trump took office.
Wednesday’s hearing was originally meant to include testimony from Department of Justice attorney Tina Ansari, who prosecuted Haim before she was removed from the case due to substantial conflicts of interest. Representatives Jim Jordan (R., Ohio) and Chip Roy (R., Texas) previously asked her to testify on Wednesday.
The reason for her absence remains unclear. A House Judiciary spokesperson did not respond to National Review’s request for comment.
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