The administration of Donald Trump has accused the Children’s Hospital of Philadelphia of engaging in insurance fraud related to the funding of gender transitions for young patients.

The Department of Justice (DOJ) has alleged that it possesses ‘evidence’ pointing to ‘fraudulent billing practices’ for medications prescribed for gender dysphoria in children at this hospital located in a liberal city.

This marks a new level of intensity in the legal struggle initiated by Trump against the children’s hospital last June when he issued a subpoena seeking private information about patients receiving gender-related care.

The Philadelphia medical facility has one of the nation’s largest gender clinics, which ‘supports children and young adults who are gender nonconforming, gender expansive and transgender,’ according to its website. 

DOJ Acting Director of the Enforcement and Affirmative Litigation Branch Lisa Hsiao made the bombshell claim in declarations submitted in Pennsylvania federal district courts on Monday. 

These sworn statements come as part of a broader federal investigation into possible criminal and civil violations of the Food, Drug, and Cosmetic Act (FDCA) regarding transgender care for children. 

Hsiao further elaborated that the violations being probed involve ‘on or off-label use by manufacturers and distributors of drugs, including puberty blockers, sex hormones, or any other drug used to facilitate a child’s so-called “gender transition.”’

She said the DOJ has ‘ample reason’ to suspect wrongdoings within the Children’s Hospital of Philadelphia’s (CHOP) Gender and Sexuality Development Program. 

Hsiao accused CHOP of using ‘incorrect diagnosis and/or billing codes’ to prescribe patients with puberty blockers or cross-sex hormones. 

CHOP allegedly does this ‘because they know that certain insurance plans may not cover off-label prescription[of these drugs] for gender-related treatment,’ she wrote.

Hsiao said that the DOJ’s suspicion is mainly driven by a slew of central precocious puberty diagnoses.

Central precocious puberty is a condition in which a child goes through puberty earlier than usual. 

According to the Mayo Clinic, puberty occurs in girls after age eight and in boys after age nine.

Hsiao said the DOJ hired contractors to analyze ‘extensive anonymized insurance claims’ that were submitted by CHOP providers. 

This analysis revealed that based on diagnosis codes observed from 2017 to 2024, CHOP or an affiliate diagnosed nearly 250 minors over the age of 10 with the condition, including ‘numerous’ teens aged 14 to 18, according to Hsiao. 

‘This is well beyond the age at which children are typically diagnosed with precocious puberty,’ she asserted. 

The FDA has approved puberty blockers such as Zoladex to treat central precocious puberty. 

Gender-affirming care doctors are legally permitted to prescribe these blockers off-label to treat gender dysphoria. 

She then referenced ‘concerning allegations’ of CHOP placing a minor on puberty blockers after his first visit and cross-sex hormones after his second with no meaningful assessment.  

Hsiao also said doctors failed ‘to provide him the necessary information regarding the risks of taking such medications.’

An earlier version of Hsiao’s filing reviewed by the Daily Mail referenced these ‘allegations’ as a ‘lawsuit.’ The Philadelphia Inquirer reported that once they asked for clarification about the lawsuit, the filing was revised to remove its mention. 

On Tuesday night, CHOP filed a motion against the DOJ to limit its power to subpoena the hospital. 

CHOP claimed the DOJ never came to the hospital with these accusations in a separate case and has argued the judge cannot consider the new evidence presented by Hsiao. 

The hospital also argued that in Hsiao’s first submission of the filing, she referenced a ‘lawsuit’ under oath, but later removed it. 

If the judge decides to consider the new evidence the DOJ presented, CHOP requested permission to file a response.

The Daily Mail has reached out to CHOP and the DOJ for comment.   

In April, Attorney General Pam Bondi vowed to investigate hospitals under the False Claims Act to see if claims have been submitted ‘to federal health care programs for any noncovered services related to radical gender experimentation.’

In July, the DOJ announced it had sent more than 20 subpoenas to doctors and clinics involved in performing transgender medical procedures on children. 

The investigations, the department said, were concerning healthcare fraud, false statements and more. 

‘Medical professionals and organizations that mutilated children in the service of a warped ideology will be held accountable by this Department of Justice,’ Bondi said.