Doctors claim Planned Parenthood could be committing fraud over 'sex change' billing

Planned Parenthood is using alternative codes when billing insurance companies for cross-sex 'treatments' in Pennsylvania, which could amount to fraud, according to some doctors. It continues to be a nationwide leader in "gender-affirming care," including among minors.

Key Takeaways:

• Planned Parenthood promotes "gender-affirming care" for minors, and has dispensed cross-sex hormones to minors without their parents' knowledge or consent.

• Planned Parenthood Keystone openly gives insurance providers the billing code for “endocrine disorder, unspecified” when giving hormones, claiming it is required to get the drugs approved.

• Multiple physicians have said that doing this could be considered fraud.

The Details:

The Washington Examiner reported that Planned Parenthood facilities in Pennsylvania, which operate under three different affiliates, have been openly using billing codes for endocrine disorders when prescribing cross-sex hormones, rather than using accurate billing codes. Specifically, the code used is "E34.9 (endocrine disorder, unspecified)" rather than the accurate "F64.9 (gender identity disorder, unspecified)."

This is something the abortion corporation openly discloses. On the Planned Parenthood of Southeastern Pennsylvania website, it reads:

In order to meet the needs of most insurance companies and patients, we typically use the code E34.9 (endocrine disorder, unspecified) and occasionally will use F64.9 (gender identity disorder, unspecified) if necessary. We recognize that much of the language around billing for gender affirming care is troublesome; we recognize this is medically necessary care and will work to decrease barriers to getting folks the care they need. If you have concerns about the specific billing claims being used with your care, please speak with your clinician.

The Planned Parenthood Western Pennsylvania site uses similar language:

Below are a list of ICD-10 diagnosis codes your provider may use:

E34.9 Endocrine disorder, unspecified
Z79.899 Other long term drug therapy
F64.1 Gender identity disorder in adolescence and adulthood
F64.8 Other gender identity disorders
F64.9 Gender identity disorder, unspecified
F64.0 Transsexualism

(Note that while we don't like the wording used in many of these codes, they are used by insurers and medical billers on a national basis and we are unfortunately required to keep the wording the same when using them because of that.)

It is not clear if other affiliates likewise engage in this kind of duplicity, but these Pennsylvania affiliates appear to be the only ones openly admitting to it.

Why It Matters:

Reports have been filed exposing this deceptive practice, including with the Federal Trade Commission (FTC), as doctors warn that it could amount to fraud.

“A huge amount of energy has been spent to develop, find which ICD codes can be used that will justify the [gender] interventions under a false pretense without pushback from insurance companies,” Dr. Eithan Haim told the Washington Examiner. “They’re actually inducing the disorder that they’re claiming to treat. Once they’re started on hormones and all that s***, they have an endocrine disorder, but it was just one that was given to them by their doctors."

In the report for Do No Harm, Dr. Kurt Miceli wrote, “Utilizing these ‘alternative’ codes is misleading and contrary to the ICD-10-CM Official Guidelines for Coding and Reporting, which requires providers to ‘[c]ode to the highest level of specificity when supported by medical record documentation.'"

Dr. Miriam Grossman testified before the FTC that the fraudulent use of these billing codes is intentional to ensure payment.

“These are physically healthy people. They have no medical diagnosis whatsoever,” she said. “They have a psychiatric diagnosis. But this E34.9 is being used in a fraudulent way, I would say, in order to get payment for the services."