Health Care, Higher Education

HHS report flags OU Physicians-Tulsa claims involving puberty blockers; OU says it complies with state law

August 19, 2026

Ray Carter

A newly released report commissioned by the U.S. Department of Health and Human Services has identified a claims-data pattern involving OU Physicians-Tulsa that HHS says warrants further scrutiny. 

The report, “Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of ‘Gender Medicine,’” analyzes nationwide insurance claims from 2015 through 2025 and says some providers used diagnosis codes associated with precocious puberty when seeking insurance coverage for puberty blockers prescribed to adolescents receiving gender-related care.

HHS identified “Board of Regents of the University of Oklahoma OU Physicians Tulsa” as one of the organizations that “billed for puberty-blocking drugs given to a patient aged 13 to 17, where the medical reason listed on the bill was puberty starting unusually early. That diagnosis normally applies to much younger children, so it is an unexpected reason to see at these ages.”

OU Physicians-Tulsa appears in the report’s Cohort B, which consists of claims for puberty blockers accompanied by a precocious-puberty diagnosis for patients ages 13 to 17.

The report does not conclude that OU Physicians-Tulsa committed fraud or knowingly submitted a false claim. Instead, it identifies the claims as a potentially anomalous billing pattern warranting further scrutiny. HHS recommends additional review to determine whether billing practices were improper or violated federal or state law. 

When reached for comment, the University of Oklahoma did not directly address the billing code analysis, but disputed any suggestion that OU Physicians-Tulsa is currently providing such treatment to minors, noting that Oklahoma law prohibits the practice and stating that OU Physicians-Tulsa complies with state law. 

“The University of Oklahoma will fully participate and cooperate in any review,” the OU statement concluded.

Vice President JD Vance, as chairman of the White House Task Force to Eliminate Fraud, and HHS Secretary Robert F. Kennedy Jr. referred hospitals and clinics identified by the report to the Department of Justice and the HHS Office of Inspector General, respectively, for possible violations of federal law. 

“HHS will follow the evidence, protect taxpayers, and hold accountable anyone who broke the law or violated the trust of patients and families,” Kennedy said.

The report identified approximately $50 million in insurance claims for puberty blockers billed using an endocrine disorder diagnostic code and nearly $11 million in claims for patients ages 13 to 17 billed using a diagnosis code for precocious puberty.

HHS says providers treating gender dysphoria have specific diagnosis codes available for communicating with insurers and federal programs, and the report argues that using other codes in their place can create potential liability.

It also noted false coding may subject medical providers to fines and damages under the federal False Claims Act as well as liability under state laws.

The HHS report noted the “traditional” age of diagnosis for precocious puberty is before age eight in girls or age nine in boys, and that treatment with puberty blockers is usually ended at about ages 10 or 11. Yet HHS identified claims from many facilities, including OU Physicians-Tulsa, involving patients ages 13 to 17 for which precocious puberty was listed as the diagnosis. 

“Puberty occurring within the normal time range is not precocious; it is simply puberty,” the report stated.

Claims data alone do not disclose the full patient record, the clinical basis for a diagnosis, the medical circumstances surrounding treatment, or who selected a billing code. 

The HHS report stated that “experimental sex-rejecting procedures” were provided to children “in rapidly increasing numbers” beginning in the late 2010s and early 2020s, “despite a paucity of adequate evidence for long-term safety and efficacy for these interventions.” Those interventions included “life-altering drugs and surgeries for children who express discomfort with their sex.”

Previously, the HHS report stated, pediatric departments in large academic medical centers and hospital systems would “traditionally generate thinner margins” compared to adult cardiology, oncology, orthopedics, and other medical and surgical specialties.

“Gender clinics changed that calculus by introducing a novel source of revenue: they promised a new stream of continuous revenue for pediatrics, endocrinology, and surgical specialties by taking physiologically healthy young people—who otherwise would not need to seek medical attention—and rendering them dependent for life on the medical system,” the HHS report stated.

The report estimated that lifetime totals for a sex-rejecting patient starting as a minor can reach $25,000 to $75,000 “even without surgeries.” In contrast, the report estimated average healthcare spending for children under the age of 18 is typically around $3,000.

“Top surgery” (mastectomy with chest masculinization for females) carries a per-procedure mean health-plan-paid cost of $12,680, with additional out-of-pocket costs of $2,244. Similarly, mammoplasty costs insurers $17,426 per patient with an additional $1,223 out-of-pocket. “Bottom surgeries”—vaginoplasty for males and phalloplasty for females—are often staged over multiple episodes, and average total costs per person reach $53,645 for vaginoplasty and $133,911 for phalloplasty.

When surgeries are included, the report estimated that individual lifetime spending on surgical interventions can “easily exceed $100,000 and approach $170,000.”

“Once initiated—often with puberty blockers or cross-sex hormones in early adolescence—the patient requires ongoing care for decades,” the report stated. “Insurance reimbursements, whether private or public, create a predictable, high-margin stream for pediatric endocrinology, adolescent medicine, plastic surgery, urology, and gynecology departments.”

In 2022, Oklahoma state lawmakers voted to block certain funding to Oklahoma Children’s Hospital at OU Health if the facility provided puberty blockers or performed sex-change surgeries on youth.

In 2023, lawmakers approved, and Gov. Kevin Stitt signed, legislation that banned the provision of irreversible sex-change surgeries, puberty blockers, and cross-hormone injections for children under the age of 18 at any facility in Oklahoma.

Those laws followed controversy involving the University of Oklahoma Children’s Hospital, which operated the Roy G. Biv Program. At that time, the website for the Oklahoma Children’s Hospital stated that officials with the Roy G. Biv Program would assist youth “moving toward gender affirmation,” including “Female-to-male transgender” and “Male-to-female transgender.”

The OU website stated the children’s hospital would provide “gender-affirming scope of treatment” that included “pausing puberty to further explore gender,” “managing gender-affirming hormone therapy,” and “helping find surgeons who perform gender-affirming surgeries.”

‘Trying to Transition Back and Will Never Be the Same’

During the 2022 floor debate, state Rep. Kevin West, R-Moore, said officials at the Oklahoma Children’s Hospital reported facilitating at least five “top” surgeries within the prior year—before Oklahoma’s ban on such procedures was enacted—and that two of the five patients had already expressed regret.

Also during floor debate, state Rep. Kyle Hilbert, a Bristow Republican who now serves as Speaker of the Oklahoma House of Representatives, said he had visited with the parent of one patient.

“I personally have talked to a parent whose daughter went through this process and regretted it and is trying to transition back and will never be the same,” Hilbert said.

The HHS report included national case studies unrelated to OU Physicians-Tulsa to illustrate broader concerns regarding youth gender care. 

Sydney Aviles “struggled with her mental health because of a sexual assault and her parents’ divorce.” She was prescribed cross-sex hormones starting at age 14 and underwent a double mastectomy at age 18, before eventually detransitioning. The report says she developed subclinical hypothyroidism, as well as an elevated red blood cell and hematocrit count.

Rose Marie spent her teenage years in foster care and was homeless at age 16. At 18, she obtained a prescription for cross-sex hormones after “a 15-minute doctor’s appointment via the app.” By 2025, she stopped taking testosterone “and began the process of detransitioning.” However, the report stated that her voice is still deep, she suffers from fatigue and weakness, she has tingling in her limbs, she struggles to use the bathroom, and her menstrual cycle is irregular.

Clementine Breen was sexually abused at age seven and encountered the concept of “gender dysphoria” at age 12 as she was feeling anxious about puberty. After a one-hour appointment, she was placed on a puberty blocker. At age 13, she was given testosterone. She eventually had a double mastectomy, after which her testosterone dosage was more than doubled. Within months, Breen reported that she “experienced severe insomnia, obsessive exercise, disordered eating, escalating anger, and eventually a psychotic episode,” and that she also “began self-harming shortly after surgery.” She was prescribed “multiple psychiatric medications simultaneously.” At 18, she independently chose to stop testosterone, at which point her “psychosis resolved.”

“Once her former doctors learned she was detransitioning, they ceased responding to emails and calls,” the HHS report stated.

Layla Jane, who was eventually diagnosed with autism, began experiencing discomfort with her sex at age 11. By age 12, she was prescribed a puberty blocker, quickly followed by testosterone injections. One month after her 13th birthday, Jane underwent a double mastectomy at Kaiser San Francisco. By age 17, Jane chose to detransition. She now “lives with joint pain, urinary dysfunction, and daily nerve damage.”

“When a child is in distress, many parents will go to any length to find help and to relieve the pain,” the HHS report stated. “These parents count on America’s pediatric hospitals, medical associations, and federal regulatory agencies to value science over ideology and people over profit when recommending medical procedures. Instead, parents encountered wolves in white lab coats who pushed vulnerable children down a path towards irreversible harm from sex-rejecting procedures.”