DOJ Accuses PA Children's Hospitals of Fraudulent Billing

Plus some brief updates on previous posts

WELCOME TO ALL OUR NEW SUBSCRIBERS! Thank you for supporting sex-based rights in Pennsylvania!! We can’t do this without you!

First some brief updates.

Will the Supreme Court Strike Down State Bans on 'Conversion Therapy'? This medical-press article claims to be pro-science and pro-patient health, yet the authors repeat the tired old myths of suicidality and TQ+ piggybacking onto legitimate LGB concerns. Nowhere do they mention the Cass Report or the recent FTC session of the dangers of “GAC” for minors.

SCOTUS Is Poised to Rule Against Colorado's Ban on So-Called Conversion Therapy For Minors. Genspect’s Erin Friday discusses why most observers anticipate SCOTUS’s striking down Colorado’s ban on alleged conversion therapy.

Man who firebombed Gov. Shapiro's home pleads guilty on all charges, gets up to 50 years in prison. The arsonist and attempted murderer missed a major opportunity! He could have played the very popular trans-get-out-of-jail-free card as the attempted assassin of SCOTUS Justice Brett Kavanaugh did. Kavanaugh’s male would-be assassin claimed to be a woman and was sentenced to only eight years in prison instead of the 50 years he should have received. Oh well. Maybe Governor Shapiro’s arsonist will change his mind if/when he gets sucked into trans ideology.

Both UPMC Children's Hospital of Pittsburgh and Children's Hospital of Philadelphia (CHOP) are under investigation by the US Department of Justice (DOJ) for alleged fraudulent billing for “GAC” for minors.

Federal officials are looking into whether doctors at Children’s Hospital of Philadelphia (CHOP) and Children’s Hospital of Pittsburgh were fudging or lying about diagnoses to get private and public health insurance companies to cover off-label drug prescriptions used to treat patients with gender dysphoria — a medical condition in which a person’s body does not match their gender identity.

The DOJ’s assertions came in the form of sworn statements, or “declarations,” submitted in Pennsylvania federal district courts as part of a federal investigation into potential criminal and civil violations of the Food, Drug and Cosmetic Act (FDCA).

…statements in the UMPC and CHOP cases broadly allege that the DOJ suspects doctors are using “incorrect diagnosis and/or billing code” to prescribe medications “because they know that certain insurance plans may not cover off-label prescription of puberty blockers or cross-sex hormones for gender-related treatment.”

The Pittsburgh Post-Gazette reports that

The filing did not levy any specific allegations against UPMC’s Children’s Hospital but alleged “the government is aware of information particular to [Children’s Hospital of Philadelphia] that raises concern that federal health care offenses may be occurring there.”

As usual, P-G disabled comments for their story.

The Pittsburgh Tribune-Review reports that

“This is a bona fide, high-priority and substantial national investigation of potential (federal Food, Drug, and Cosmetic Act) violations in the provision of gender-related care for minors. Substantial government resources have been assigned to it,” wrote Lisa K. Hsiao, the acting director of the Justice Department’s consumer protection branch.

The legal brief calls it an investigation “of major public importance given its implications for the safety of minor patients.”

Courtesy of ROAR Women NYC, a registered nurse employed in the utilization management department, also known as the authorization department, of an insurance company writes about the significance of DOJ’s insurance fraud case.

Penalties for insurance fraud add up quickly. Civil penalties under the Medicare and Medicaid False Claims Act [31 U.S.C. § § 3729-3733], which collects settlements from fraud billed to federal programs, and includes fines of up to three times plus $11,000 (inflation-adjusted) for each fraudulent claim.

…

It doesn’t end there. In addition to civil penalties, insurance fraud can incur criminal penalties [18 U.S.C. § 287] as well. Providers may lose their license to practice, be banned from participating in federal programs such as Medicare, Medicaid, and TRICARE, or even spend time in prison. [Emphases in original.]

The DOJ’s case against the PA children’s hospitals is based on their alleged use of

… a fraudulent billing code to obtain insurance coverage for “gender” treatments.

The billing code, intended for children with precocious puberty, was allegedly misused for 250 patients aged 10 to 18 from 2017 to 2024. According to the DOJ, the treatments covered were not intended to treat precocious puberty, but rather used as GAC on the basis of a claimed “gender identity.” In other words, the DOJ claims these providers committed insurance fraud by using the wrong billing code for the patients’ diagnosis. [Emphases in original.]

This sounds like insurance fraud by any other name. Read the nurse’s article for additional details.

“GAC” for minors is legal in Pennsylvania. However, lying to an insurance company to receive payment for services that were not provided is not. PA4SBR will keep readers updated on this investigation. PLEASE support ROAR Women NYC — they support us!

Today is Ada Lovelace Day! Ada Lovelace is recognized as the world’s first computer programmer.

Ada Lovelace Day (ALD) is an international celebration of the achievements of women in science, technology, engineering, and maths (STEM). It aims to increase the profile of women in STEM and, in doing so, create new role models who will encourage more girls into STEM careers and support women already working in STEM. Founded in 2009 by Suw Charman-Anderson, it is now held every year on the second Tuesday of October.

Please support girls who want careers in STEM.

[Meme from BoredPanda.com.]