Texas Children’s Hospital allegedly committed Medicaid fraud by billing for transgender procedures, according to a new whistleblower at the hospital.
Vanessa Sivadge, a nurse at Texas Children’s Hospital, told journalist Christopher Rufo in City Journal that she identified two patients at the hospital who received coverage for transgender hormones and surgeries through the Texas Children’s Health Plan STAR, which is a “no-cost Medicaid managed care plan.” The allegations, if true, may violate state law.
Texas Health and Human Services told Rufo that its Medicaid program has “never covered ‘gender-affirming’ surgery or prescription drugs for the purpose of ‘gender-affirming’ care.” According to a Kaiser Family Foundation report published in 2022, Texas expressly excludes coverage of ‘gender-affirming’ health services through Medicaid.
The two patients identified by Sivadge were prescribed transgender hormones at the hospital in 2022 when they were 16 years old.
“The largest children’s hospital in the country is illegally billing Medicaid for transgender procedures,” Sivadge told City Journal. “It is evident that the hospital continues to believe it is above the law not just by concealing the existence of their transgender medicine program from the public, but by stealing from the federal government.”
Rufo reported Tuesday that Attorney General Ken Paxton’s office confirmed the AG was investigating the allegations of Medicaid fraud at Texas Children’s Hospital.
“Based on the facts we have, the only reasonable conclusion is that Texas Children’s Hospital was using Texas Medicaid funds to pay for ‘gender-affirming care,’ contrary to Texas law,” a legal expert told City Journal.
Sivadge named two specific hospital employees who she said were involved in the alleged medical fraud: physicians Richard Ogden Roberts and David Paul. Neither responded to DX‘s request for comment.
The Texas Children’s Hospital communications team did not respond to a request for comment. DX also reached out to each member of the Texas Children’s Hospital board who still works for the organization based on its latest tax forms, as the hospital did not respond to requests for an updated board member list, as well as the hospital’s leadership team in full. That includes:
Mark Wallace, CEO; Debra F. Sukin, president; Weldon Gage, executive vice president and chief financial officer; Dean Andropoulos, anesthesiologist-in-chief; Michael A. Belfort, obstetrician/gynecologist-in-chief; Larry Hollier Jr., surgeon-in-chief; Thierry Huisman, radiologist-in-chief; Lara Shekerdemian, pediatrician-in-chief; Jeffrey Shilt, community-in-chief; James Versalovic, pathologist-in-chief; Huda Zoghbi, research-in-chief; Linda Aldred, executive vice president and chief human resources officer; Myra Davis, executive vice president and chief information and innovation officer; Dan DiPrisco, executive vice president; Matt Girotto, executive vice president; Keith Nelson, executive vice president and chief investment officer; Tabitha Rice, executive vice president; and Russ Williams, senior vice president.
None responded.
Sivadge initially spoke with Rufo in a May 2023 interview as an anonymous whistleblower critical of the hospital’s ubiquitous administration of hormone inhibitors and transgender hormones.
Rufo reported Tuesday that the FBI appeared at Sivadge’s house two months after the interview last year. Two FBI agents — Paul Nixon and David McBride — allegedly told her that she was a “person of interest” in the investigation against another whistleblower at Texas Children’s Hospital, Dr. Eithan Haim.
DX was unable to independently verify the names of the FBI agents:
“While individuals are free to speak about their interactions with the FBI, we do not discuss, describe, or confirm any contact we allegedly have with individuals,” Connor Hagan, an FBI public affairs officer, told The Dallas Express.
“FBI and Department of Justice guidelines do not allow me to provide more information at this time,” he wrote.
Haim was the whistleblower who exposed to City Journal last year that Texas Children’s Hospital had continued its transgender program for minors after promising to end it over legal concerns. The story prompted Texas lawmakers to ban transgender procedures for minors.
However, Haim soon became the subject of a targeted federal investigation and was indicted on four felony counts this month, as previously reported by The Dallas Express. He pleaded not guilty.
The unsealed indictment alleges Haim “obtained unauthorized individually identifiable health HIPAA protected information on pediatric patients” and “caused malicious harm to TCH, pediatric patients at TCH and its physicians by contacting a media contact.”
Haim and Rufo said the leaked documents about the transgender program redacted private patient information.
“The reason they have to come after me is to make an example out of me so other whistleblowers don’t speak out like I did,” Haim previously told DX. “In this case, the process is the punishment.”
