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@EithanHaim - Eithan Haim MD

If you want to understand the DOJ's investigation into gender clinics' fraudulent billing practices, best place to start is this Kaiser Health News article. It tells the story of Tim Chevalier - a lady who believes she's a man who needs laser hair removal for a "phalloplasty." https://t.co/UeNpkiZRjS

@EithanHaim - Eithan Haim MD

Article starts by explaining Chevalier's insurance, Anthem, denied coverage for laser hair removal because it was "cosmetic." It goes on to explain that "insurance companies, sometimes question mental health claims more rigorously than those for physical illnesses." https://t.co/nO2FVmhFIR

@EithanHaim - Eithan Haim MD

The article includes Johanna Olson-Kennedy, one of the trans industry's apex predators. She endorses the move from ICD-10 (currently in use) to ICD-11. Her reason is that gender diagnoses would "no longer be a mental health condition, but sexual health one." Since "sexual health" diagnosis codes are considered physical condition as opposed to a mental health condition, the idea is that insurance would more easily cover the hormones and surgery that are part of "gender affirming care."

@EithanHaim - Eithan Haim MD

Since hormones/surgery are easier to get covered in ICD-10 with codes for physical diseases, what are gender docs doing in the meantime? Article explains - "enter the ICD-10 code for pelvic pain, as opposed to gender dysphoria" for coverage of gender affirming hysterectomy. They simply "enter the ICD-10 code" and magically the insurance money red light turns green.

@EithanHaim - Eithan Haim MD

The way the paragraph in previous post reads is not that Gorton's patient had pelvic pain but he entered the code for pelvic pain and it worked to cover a hysterectomy. Almost like medicine in reverse - a patient decides what drugs/surgery they want and doctors figure out a way to make it happen.

@EithanHaim - Eithan Haim MD

Medical fraud is difficult to prove when diagnosis codes relates to something subjective and self reported like "pelvic pain." It's a whole different story with the diagnosis codes the DOJ is investigating (i.e. endocrine abnormality, unspecified - E34.9). https://t.co/7zArdJ38HN

@EithanHaim - Eithan Haim MD

The screenshot shows that the E34.9 code will cover lab testing and hormones and therefore provide the means for "gender affirming care" without any of the insurance barriers attached to the mental health categorization of "gender identity disorder" in ICD-10. You can see how this code serves the same purpose as the example mentioned in the article with the "pelvic pain" diagnosis code for a "gender affirming hysterectomies." However, it has a very discrete definition that leaves no room for interpretation since it relies on objective biochemical evidence (i.e. lab testing). A endocrine disorder is either there or it isn't.

@EithanHaim - Eithan Haim MD

To give you a sense of scope of how prevalent this may be, consider a study from 2023 (link to analysis below) that showed 95% of all patients (1,408 patients) with a gender diagnosis code also had an E34.9 diagnosis code. https://t.co/UPCki0aVIe

@EithanHaim - Eithan Haim MD

Is there a way to know the extent of fraudulent billing in gender clinics for the "endocrine abnormality" diagnosis code, as alleged by DOJ? I believe there is. A 2023 study from the University of Iowa retrospectively reviewed the medical charts of a large number of patients, looking at gender identification and diagnosis patterns. It found 95% of "gender expansive" patients (1,408 out of 1,450) were coded for "endocrine abnormality." And nearly 90% (1,295 out of 1,450) were receiving hormones. (image 1) It's only too perfect that this study was published by a bunch of gender docs and woke med students. They probably didn't realize it but one of their most significant findings would also be quite significant for the Trump DOJ - 96% overlap between "gender dysphoria" and "endocrine abnormality" diagnosis codes (image 2). This is significant because the "endocrine abnormality" diagnosis code is the exact ICD code mentioned in DOJ affidavits as the means for gender clinics to fraudulently bill insurance companies for hormones and lab testing. (quoted X post) So, back to original question - what is the extent of fraudulent billing for the "endocrine abnormality" diagnosis code? Based on this study, it is possible that up to 95% of all "endocrine abnormality" submissions from gender clinics are fraudulent! I get that this finding is borderline unbelievable. But I've seen this pattern of coding from individuals who asked me to review their gender clinic records. I can say with certainty that this is real. I still wonder though - is the University of Iowa one of those hospitals that received a subpoena from the DOJ? According to this study, it may be something the Trump DOJ should seriously consider.

@EithanHaim - Eithan Haim MD

It just so happens that the exact scam described in this clip two years ago is what the Trump DOJ are currently investigating! (see image) Podcast claims doctors concealed abortions using diagnoses like "miscarriage." DOJ affidavit from last week claims gender clinics concealed

Video Transcript AI Summary

Speaker 0 and Speaker 1 discuss how diagnosis codes can create false claims under the False Claims Act. In Medicaid claims, the physician and health system submit that they provided specific services and should be paid a certain amount, accompanied by a diagnosis code and a procedural code. If abortion services are miscoded as miscarriage care, the claim would be billed to Medicaid as miscarriage care. The health system would then bill the patient’s insurance—Medicaid—instead, leading to a false claim. The essence is that a misrepresented diagnosis code can trigger liability under the False Claims Act because the claim to Medicaid would be for services not actually provided as claimed.

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Full Transcript

Speaker 0: And so they are unique in having the possibility of a diagnosis code qualify as a false claim under the False Claims Act. Could you talk a little bit about that? Speaker 1: In a Medicaid claim, the physician and the health systems that's submitting the bill to Medicaid saying, we provided these services. We should get paid x amount for these services. They need to submit a diagnosis code saying, okay. Here's what we diagnose the patient with, as well as a procedural code. Okay, here's what we did about it. If you are miscoding an abortion that's been provided as miscarriage care, that would be billed to Medicaid. And if you're a physician doing that, your health system is going to say, Doctor. Smith provided miscarriage services, so we're going to bill to the patient's insurance, that insurance is Medicaid. That ends up being a false claim, being a bill that Medicaid wouldn't pay except for the fact that there was this miscarriage, but it was in reality an abortion.

@EithanHaim - Eithan Haim MD

Knowing what you know now, ask yourself this - for the aforementioned 1,408 gender patients with an E34.9 ICD code, what percent do you think actually had a diagnosable endocrine condition? My bet would be 0%. I would also bet that 100% of those E34.9 codes were fraudulently submitted for the purpose of paying for labs and hormones that would have not otherwise been covered. My one stipulation would be that the only endocrine disorder these patients had were the ones the doctors gave them. That is certainly the truth of the matter. Good thing is that the Trump DOJ is starting to see it the same way. Hopefully soon we will see a few of these butchers behind bars.

@EithanHaim - Eithan Haim MD

I did a deep dive into Sotomayor, Kagan, and Jackson's dissenting opinion. It's even worse than I expected. Follow this thread to see for yourself. 🧵

@EithanHaim - Eithan Haim MD

Their main argument is that the law discriminates on the basis of sex since there are certain medications that make boys look like boys, vice versa for girls. But that's insane. These treatments are meant for diagnosable pathologies in order to restore normal physiology. https://t.co/J2FwdesXIs

@EithanHaim - Eithan Haim MD

It would be like saying a patient without cancer but "identifies as having cancer" is being discriminated against because a doctor is refusing to give them chemotherapy. They have the audacity to claim the majority opinion "contorts logic" while they rely on anti-logic. https://t.co/beAmZmAsoP

@EithanHaim - Eithan Haim MD

They go on for quite some time as if they are certified, practicing doctors. They describe commonly treated endocrine pathologies and how hormones are used to treat these conditions. These genius legal minds are setting up a shifty play for their next move... https://t.co/jBpfRWgnPs

@EithanHaim - Eithan Haim MD

After their prolonged dissertation on basic endocrine pathology, they claim these hormones are used in children whose "gender identity is inconsistent with their sex identified at birth." This statement is sheer medical lunacy. It is not real. It has no basis in objective, observable reality. It has as much legitimacy as your local Voodoo witchdoctor - like using a rabbit's foot to treat a hemorrhaging carotid artery.

@EithanHaim - Eithan Haim MD

As if it couldn't get any crazier, they cite WPATH! This is the same organization whose legitimacy was completely decimated during the oral arguments. It's like relying on Purdue Pharma to justify the safety of Oxycontin to treat a mild headache. https://t.co/IPc3eI4Jim

@EithanHaim - Eithan Haim MD

Almost as if they did not pay attention to a single thing during the oral arguments, these Justices even repeat the thoroughly debunked WPATH talking point that puberty blockers merely "pause puberty." I guess they missed the part about puberty blockers causing infertility. https://t.co/IRpGATeKhl

@EithanHaim - Eithan Haim MD

The Justices then claim it is a matter of "life and death." Thus, it appears they also missed the part when Chase Strangio, the lead ACLU attorney, conceded to Justice Alito that "gender affirming care" actually has no impact on rates of completed suicide. This is like a Judge endorsing a guilty verdict in a murder case after finding out the victim is still alive.

@EithanHaim - Eithan Haim MD

After this their arguments progress even further into a tailspin of anti-logic and WPATH propaganda. And although we won this case, we should not fail to appreciate the severity of the situation. These Judges sit on the highest court in our country yet live in a reality informed by fantasy. This is not a good state of affairs.

@EithanHaim - Eithan Haim MD

At President Trump's speech last night, I was sitting right behind the Democrats in the gallery. I had a perfect bird's eye view of everything. No doubt very dramatic for all of those watching but there was so much more the cameras missed. 🧵

@EithanHaim - Eithan Haim MD

Not only did the Dems not applaud or stand for the stories honoring average Americans but neither did their guests in the gallery. Even for the most heartwarming moments most stayed seated, very few ever applauded. It was heart-breaking to see.

@EithanHaim - Eithan Haim MD

During these moments I could see entire rows of Democrats staring down at their phones. I was close enough to see what they were looking at - most were texting or scrolling through social media feeds.

@EithanHaim - Eithan Haim MD

The only moment during the speech that generated enthusiastic, collective applause was when Trump mentioned spending hundreds of billions on Ukraine. There were 5 or 6 Dems that immediately pulled out Ukrainian flags and started waving them. This was notable since their applause was not meant to celebrate any result of that spending (i.e. a tangible victory for Ukraine or benefit to America) but was in response to the mention of "spending" itself. The fact that this was so natural and immediate was unnerving. It was the only thing that pulled their faces away from their phones. Not the celebration of life in our homeland but death of hundreds of thousands in a foreign one.

@EithanHaim - Eithan Haim MD

Beyond the applause, there were a few other other notable observations. After Al Green started yelling and shaking his cane at Trump, the first person security approached was not Green but Nancy Pelosi, almost like she was the pit boss for the Dem side. I could tell she not pleased since I didn't even see her turn her head towards the security guard. This would have required Pelosi to look towards her right side which was the direction where Green was embarrassing himself in front of the country. Not really surprised by her reaction since this would have compounded the collective sense of defeat on the Dem side of the chamber.

@EithanHaim - Eithan Haim MD

While the cameras were focused on the characters on the chamber floor, they missed the ones in the gallery. Like a young woman caddy corner to my left. It looked like she was dressed in sweats and was fully passed out for the entire speech. And it didn't seem like this was an act of protest or defiance but that she was actually sleeping, working her way through multiple REM cycles. She even used the tight seating in the gallery to her benefit - relying on her neighbors' shoulders and arms to achieve the most comfortable position possible for an extended tiger snooze. At one point I thought she was snoring. Unfortunately, I was too far away to obtain audible verification.

@EithanHaim - Eithan Haim MD

Then there was a young guy with a voluminous shoulder-length mullet, a Lieutenant Dan-esque military jacket, and blue jeans. One of the guys sitting next to me said it was likely one of Peter Thiels famous tech prodigies. Probably top three coolest people in the room I imagine.

@EithanHaim - Eithan Haim MD

Then there was the entire row of mainstream media journalists - about a dozen or so - directly behind Trump in the gallery. What made this stand out was that they all had the same grey MacBook which formed a wall of apple logos. It was too symbolic for the current moment in American history. The irony was almost too much given the viral video earlier that day which showed over twenty Democrat senators reading the same script, using the same microphone, producing one of the most cringeworthy displays of shameless inauthenticity.

@EithanHaim - Eithan Haim MD

But the most remarkable part of it all was the indescribable energy coming from the Republicans. It was truly a sight to see such an impressive group of people, from every possible background and every political persuasion coalesce around a shared vision. One of the most important moments in American history and I was able to be a part of it. Will be forever grateful for Senator Hawley having me as a guest. @HawleyMO.

@EithanHaim - Eithan Haim MD

Today is a beautiful day! Got a great phone call from @BrandonMShow and Senator @HawleyMO this morning. And finally got my guns back! G-d bless America and G-d bless Texas!! https://t.co/FcS30LSjKI

@EithanHaim - Eithan Haim MD

WE DID IT!!!! WE WON!!!!!!! https://t.co/M1iT2PeutM

@EithanHaim - Eithan Haim MD

This is an example of a surgical consent for a penile inversion vaginoplasty. It may seem very subtle but as a surgeon this stood out as extremely atypical - the fact that in part A) they specifically note that "I shall not have any organs which would enable me to birth children or to have menstrual periods." The reason this is so odd is that no other surgical consent contains language that is affirmatively directed at dispelling something which is clearly not possible. But why go through the effort to include this language if there wasn't something to protect the surgeon against? I believe the reason is obvious - the surgeons are protecting themselves from the liability of perpetuating the fallacy of the ideology. Everyone (including the surgeons, professional medical societies, political and social institutions) affirm the patient will become/has always been a woman but when it comes time to bring out the surgical instruments - the last irreversible step - the surgeons return to biological reality. But does this final warning serve its purpose when it stands up against an ingrained ideology within the mind of the patient? Or is it that the inclusion of this warning is acknowledgment that it stood no chance in the first place?

@EithanHaim - Eithan Haim MD

"This is like the new wave of kids." These are the 15 and 17-year-old boys who had their puberty blocked and look like 11-year-old girls. The changes may be gradual, but it is like a million micro-surgeries that happen on the cellular level. Profoundly tragic. https://t.co/x1QmodGkkW