With the Trump administration successfully shielding its predecessor’s mail-order abortion pill regime from legal challenge before midterm elections, depriving Democrats of a potent campaign issue while its Food and Drug Administration decides whether to reinstate in-person prescribing rules, a more tempting target is growing in visibility.An undercover investigation by a center-right think tank purports to expose a network of activists and medical providers using deception to help families obtain and pay for so-called gender-affirming care – puberty blockers, cross-sex hormones and surgical removal of healthy breasts and genitals – that is prohibited where they live or not covered by insurance.
The Manhattan Institute’s City Journal report highlights the Campaign for Southern Equality, which lost its primary cause when the Supreme Court legalized same-sex marriage nationwide, as the key hub linking families of children who identify as the opposite sex or no sex to medical providers willing to circumvent GAC restrictions on the books in most states.
It said many of CSE’s recommended providers, “with the organization’s knowledge,” coached families on how to “circumvent state restrictions and allow minors to continue receiving medical interventions in their home states,” using non-gender dysphoria diagnosis codes to fool insurance and pharmacies and mailing medications directly to patients’ homes.
It’s not the first time North Carolina-based CSE has shown up on a list of organizations that allegedly facilitate the circumvention of state Medicaid restrictions and promote insurance billing fraud by obscuring the intended purpose of treatment approved for precocious puberty, hormone deficiencies and unspecific endocrine disorders, among other conditions.
Medical advocacy group Do No Harm flagged CSE’s work in a broader report this spring on the ecosystem of alleged GAC billing fraud.
CSE Executive Director Jasmine Beach Ferrara and Communications Manager Emma Chinn did not answer queries about the report’s portrayal of CSE’s work and, if uncontested, how CSE defends the work in light of federal investigations of GAC billing fraud.
The organization’s staff page, still linked from its “about” page, has redirected to its home page for more than a year and a half, but Just the News found an intact archive with staff contacts from a week before President Trump’s second inauguration in January 2025.
‘The evidence of misconduct is astonishing’
The new report complements the Trump administration’s recent enthusiasm for threatening to cut off federal money and prosecute providers for GAC billing fraud, and for improving care for detransitions by issuing new diagnosis codes that make them visible in medicine and help them get restorative treatment and insurance coverage.
In contrast to the Justice Department’s hostility toward GOP-led states seeking to stanch the flood of abortion pills from out of state that render their pro-life laws toothless, DOJ’s case against Texas Children’s Hospital for hidden GAC practices on minors prompted a settlement that created the nation’s first detransition clinic, which opened at TCH last week.
TCH whistleblower Eithan Haim recently posted what he called the first in a series of comprehensive reviews of detransitioners’ medical records, with their consent, showing their doctors “employing what appears to be proxy diagnosis codes” as a “false pretext to secure insurance payment for hormones and surgery.”
The first review concerns Fox Varian, the detransitioner whose $2 million jury award against her medical providers for malpractice sparked panic across the industry. They used “breast hypertrophy” as a proxy for gender dysphoria to secure her double mastectomy, the same trickery recommended by CSE, according to Haim.
Rhode Island Hospital has also turned over more than 112,000 pages of records on GAC for minors in response to a DOJ administrative subpoena pursued through federal court in Texas. Though a Rhode Island federal judge banned DOJ from reviewing the records, the Texas federal court has required their submission for in-chambers review.
“While DOJ attorneys are fighting tooth and nail to obtain these records, establishment forces are doing everything they can to prevent that from happening,” Haim said. “There is no mystery behind the unprecedented resistance to this otherwise standard request […] the evidence of misconduct is astonishing.”
