Pennsylvania’s Puberty Blocker Claims Under Investigation for Fraud

A significant rise in the number of adolescents receiving puberty blockers in Pennsylvania is currently under investigation due to allegations of fraudulent billing practices. Data reveals that over 220 claims for puberty blockers were processed for minors aged 10 to 13 using the International Classification of Diseases (ICD) billing code, E30.1, designated for precocious puberty, between January 1, 2013, and December 31, 2024. This surge has reportedly cost taxpayers more than $1.8 million.

The number of claims for this age group escalated dramatically, increasing from zero in 2012 to 47 by 2016. The U.S. Department of Justice (DOJ) has expressed concerns that this billing code may have been misused by healthcare providers to secure insurance coverage for interventions not typically associated with precocious puberty. Dr. Kurt Miceli, medical director at Do No Harm, stated, “A spike of this magnitude in the diagnosis of precocious puberty — especially among children past the usual age — is highly atypical and raises the very real possibility that the diagnosis has been used as a billing workaround.”

Central Precocious Puberty (CPP) is typically diagnosed in children before the age of 10, as it results from the early activation of the pituitary gland, which leads to increased production of sex hormones. Dr. Roy Eappen, an endocrinologist and Senior Do No Harm Fellow, emphasized, “I would be surprised to see girls or boys on puberty blockers for precocious puberty after age 8.”

The data indicates a staggering increase of over 2,100% in reimbursement claims for puberty blockers using the E30.1 code from 2013 to 2017. Total reimbursements for minors under 18 soared from $34,906 in 2013 to $786,728 in 2017, according to the Pennsylvania Department of Human Services (PA DHS). Prior to 2013, there were no claims for puberty blockers associated with this diagnosis in any age group.

Concerns Over Billing Practices

The DOJ is actively probing potential billing fraud related to puberty blockers in Pennsylvania and several other states. In an October 2025 court filing, the DOJ noted that initiating puberty blockers at ages 10 and above under the diagnosis of precocious puberty raises suspicions of fraudulent activity. More than 20 healthcare providers offering gender-related services have been subpoenaed, including the Children’s Hospital of Philadelphia (CHOP) and Boston Children’s Hospital (BCH).

An analysis of insurance claims has indicated that nearly 250 minors at CHOP were diagnosed with CPP at age 10 or older between 2017 and 2024. This diagnosis is notably atypical for children at these ages. Dr. Quentin Van Meter, a pediatric endocrinologist, commented, “It would be very, very rare for a child to be diagnosed with precocious puberty at age 10.” He expressed concern that many of these cases could involve children who identify as transgender, leading to possible misclassification for insurance purposes.

The state of Pennsylvania has reportedly spent over $76 million on puberty-blocking medications for minors aged 18 and under from January 1, 2020, to December 31, 2024, with an average cost per claim exceeding $11,200. Claims for minors aged 14 to 18 exceeded 1,000, while there were more than 1,900 claims for those aged 10 to 13.

Legal Challenges and Responses

In response to the DOJ’s investigation, CHOP filed a motion to limit the subpoena, arguing that it infringes on patient privacy rights. The DOJ countered by stating that the requested information is essential for determining whether the gender clinic improperly used billing codes with fraudulent intent. The court documents reveal that linking patient records to billing claims could provide evidence of misdiagnosis.

Judges have recently weighed in on the matter. In November 2025, a federal judge ruled against part of the DOJ’s subpoena, asserting that providing gender-affirming care complies with Pennsylvania’s medical standards. Pennsylvania Governor Josh Shapiro supported the CHOP gender clinic, claiming the DOJ’s actions sought to intimidate medical providers from delivering necessary healthcare.

BCH also faces scrutiny, having reported a significant increase in CPP diagnoses for children aged 10 and older from 2020 to 2023. The DOJ’s records noted a shift from diagnosing almost no 11-year-olds with CPP in prior years to 50 diagnoses in 2022, raising further questions about billing practices.

As the investigation unfolds, the DOJ continues to gather evidence. Texas Attorney General Ken Paxton has also raised allegations of fraudulent billing practices, asserting that some providers may have used deceptive codes to circumvent state laws prohibiting certain medical interventions for minors.

The growing scrutiny of billing practices for puberty blockers in Pennsylvania highlights the complexities surrounding pediatric care and the potential for misuse of medical codes. As investigations continue, the implications for healthcare providers and patients remain uncertain.