Federal prosecutors indicated in court filings on Tuesday that Boston Children’s Hospital (BCH) might be using misleading billing codes to obtain insurance coverage for minors needing puberty blockers.
For the first time since 2015, BCH has reported diagnosing a considerable number of children over the age of 10 with central precocious puberty (CPP), which seems peculiar since 10 years is typically when puberty begins. This analysis comes from anonymized insurance data reviewed by the government.
The government stated, “These large-scale late-stage diagnoses raise suspicions that BCH may have incorrectly diagnosed certain children with CPP to encourage insurance companies to approve puberty blockers for older children experiencing gender dysphoria.” They stressed that misleading a diagnosis for payment could constitute a federal medical crime.
Precocious puberty is defined as sexual development occurring before age 8 for girls and 9 for boys. BCH’s website notes that they would generally expect few cases of CPP in 10-year-olds. Dr. Curt Miceli, the medical director at Do No Harm, mentioned to DCNF that a spike in diagnoses among older age groups is certainly concerning.
Neither the Boston Children’s Hospital nor the Department of Justice (DOJ) responded to inquiries for comment.
The gathered data highlighted a “significant spike” in questionable diagnoses from 2020 to 2023, noting even a 22-year-old had been diagnosed with CPP. BCH describes delayed puberty as a situation where sexual development is incomplete by age 13 for girls and 14 for boys, and its treatment often involves hormone therapy rather than puberty blockers.
The government claimed, “There is no clear explanation as to why BCH had almost no 11-year-olds diagnosed with CPP between 2017 and 2019, but diagnosed 50 such cases in 2022.” Puberty blocking medications can be quite costly, and while these drugs are FDA-approved for treating precocious puberty, they aren’t approved for gender dysphoria.
According to Lisa Hsiao, acting director of the Justice Department’s Enforcement and Affirmative Litigation Division, there’s evidence suggesting fraudulent practices to secure insurance coverage for medical interventions related to child gender reassignment, as certain insurance plans often do not cover off-label prescriptions for puberty blockers.
The newly released information was part of the government’s motion requesting a judge to modify existing orders about the case. In July, the Department of Justice had already issued over 20 subpoenas to clinics providing transgender treatment to minors.
Judge Myung Joon, appointed by Biden, contended that the government was acting in “bad faith” and highlighted that there had not been any substantial evidence that BCH engaged in fraudulent billing practices. He expressed concerns about the extensive scope of the documents requested, including thousands of personnel files.
Joon noted, “Massachusetts does not prohibit gender-affirming care, and there is a diagnosis code for billing purposes. It’s hard to grasp what the government aims to investigate at BCH.”
Dr. Jeremy Carswell from BCH mentioned at a 2020 conference that puberty blockers were being distributed broadly.
BCH, known as America’s first pediatric gender clinic, has reportedly received $1.4 million from Massachusetts for gender transition services between January 2015 and May 2023. In July, BCH attempted to keep its filings from public scrutiny while fighting the subpoena, but a judge rejected their attempt to seal the docket.
