The U.S. Committee on Oversight and Accountability is now investigating Texas Children’s Hospital (TCH) for allegedly billing the government for transgender medical interventions.
Texas law prohibits people from paying for transgender medical interventions with Medicare or Medicaid. But Vanessa Sivadge, a nurse practitioner at TCH, claims several patients receiving so-called “gender-affirming care” at the hospital were simultaneously enrolled in its “no-cost Medicaid managed care plan.”
Investigative journalist Christopher Rufo published Sivadge’s accusations last month, prompting Texas Attorney General Paxton to start investigating TCH for Medicaid fraud —providing false treatment information to get Medicaid to pay for prohibited services.
Now, the feds are involved.
Representatives Pete Sessions (TX) and Lisa McClain (MI), chairs of the subcommittees on Government Operations and the Federal Workforce and on Health Care and Financial Services, respectively, launched a probe into TCH on July 17, writing:
We are concerned that medical providers at TCH are falsifying diagnosis codes for patients seeking gender transition care to obtain Medicaid payment for noncovered services.
In letters announcing the investigation to the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS), investigators alluded to reviewing specific instances of fraud at TCH:
We understand a TCH provider…appears to have fraudulently diagnosed a biologically female patient with testosterone deficiency and hypergonadism in order to obtain Medicaid approval for testosterone treatment that would otherwise be denied under Texas Medicaid regulations if prescribed for the purpose of gender transition.
Though shockingly unethical, Medicaid fraud isn’t uncommon. The U.S Government Accountability Office (GAO) has classified Medicaid a “high-risk” program for more than two decades because of its rapid expansion, high endowment and the frequency of which it is defrauded.
The House Oversight Committee estimates Medicaid, and therefore taxpayers, paid $50 billion for fraudulent medical treatments in fiscal year 2023.
Sessions and McClain aren’t only interested in whether TCH committed Medicaid fraud — they want to know whether the CMS and HHS have been investigating the allegations.
When Dr. Eithan Haim, a former surgical resident at TCH, accused the hospital of performing secret transgender medical interventions on minors, HHS dispatched agents to his door within a month of him blowing the whistle.
Now, Haim is facing up to ten years in prison and $250,000 in fines, purportedly for violating medical privacy laws.
The representatives worry about the consequences for whistleblowers if the federal government has not investigated alleged Medicaid fraud at TCH with the same alacrity as it investigated Haim.
“Deprioritizing the investigation of fraud could have a chilling effect, intentional or otherwise, on whistleblowers bring forward fraudulent evidence of billing,” they write in the letter to CMS, continuing:
At [Texas Children’s Hospital] and elsewhere, potential whistleblowers seeking to disclose Medicaid fraud and other unlawful behavior have seemingly been put on notice: the federal government will target individuals looking to expose illegal actions at hospitals while turning a blind eye to Medicaid fraud and other wrongful hospital conduct they seek to expose.
Sessions and McClain have ordered CMS to disclose all information related to any investigation they’ve launched into Texas or TCH, as well as information regarding incidences of Medicaid fraud for transgender medical interventions nationally, by July 31.
Chrisi Grimm, Inspector General of the Department of Health and Human Services, is also supposed to brief the investigatory committee on Medicaid fraud by that date.
This is a developing story. The Daily Citizen will continue to publish updates.
Additional Articles and Resources
Texas Children’s Hospital Embroiled In Fraud Scandal as Haim Case Kicks Off
Focus on the Family exists to help families, and that includes help navigating the issues of homosexuality and transgenderism. Focus offers a free, one-time counseling consultation with a licensed or pastoral counselor. To request a counseling consultation, call 1-855-771-HELP (4357) or fill out our Counseling Consultation Request Form.
Addressing Gender Identity with Honesty and Compassion
The Journey Back to My True Identity
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