AP Health

Tennessee attorney general says seeking clinic’s transgender patient records part of fraud probe

NASHVILLE, Tenn. (AP) — Tennessee’s top legal chief said Wednesday that Vanderbilt University Medical Center turning over medical records for transgender patients is part of a “run-of-the-mill fraud investigation” and argued that his office purposefully kept the probe private to avoid a “media circus.”

“We understand patients are concerned that VUMC produced their records to this office, especially when those patients received abrupt notice without any context,” Attorney General Jonathan Skrmetti’s office said in a statement. “To reiterate, this investigation is directed solely at VUMC and related providers and not at patients or their families.”

News of the investigation broke earlier this week when the hospital confirmed that it had been providing transgender patient records to the attorney general’s office. The attorney general’s office said this has happened since December 2022 and has maintained that the records are confidential. But the investigation has sparked unease among families living in a ruby red state where GOP lawmakers sought to ban gender-affirming care for transgender youth and limit LGBTQ rights.

Meanwhile, the attorney general’s office said it was surprised that Vanderbilt University Medical Center informed patients about releasing the records. Skrmetti’s office added that they chose to investigate after being tipped off in the summer of 2022 “that a VUMC doctor publicly described her manipulation of medical billing codes to evade coverage limitations on gender-related treatment.”

“The Attorney General has no desire to turn a run-of-the-mill fraud investigation into a media circus,” the office said in its statement.

Vanderbilt University Medical Center spokesperson John Howser said Wednesday that the hospital had no comment on Skrmetti office’s latest statement.

It’s unclear if the incident that prompted the attorney general investigation is related to videos that surfaced last September by conservative commentator Matt Walsh. Those videos included footage of a medical center doctor touting that gender-affirming procedures are “huge money makers” for hospitals.

Vanderbilt paused all gender-affirming surgeries for minors afterward, while Republican Gov. Bill Lee and others demanded an investigation was necessary — though to date, no law enforcement has confirmed those videos led to one.

Tennessee’s new ban on gender-affirming care for transgender youth will take effect in less than two weeks, barring action by a judge as both families and the U.S. Department of Justice have sought to block the law’s implementation.

The law would prohibit doctors from providing gender-affirming care to anyone under 18, including prescribing puberty blockers and hormones. But it would allow doctors to perform these medical services if the patient’s care had begun prior to July 1. However, that care must end by March 31, 2024.

At least 20 states have now enacted laws restricting or banning gender-affirming medical care for transgender minors, and most of those states face lawsuits. A federal judge struck down Arkansas’ ban as unconstitutional, and federal judges have temporarily blocked bans in Alabama and Indiana. Oklahoma has agreed to not enforce its ban while opponents seek a temporary court order blocking it. A federal judge has blocked Florida from enforcing its ban on three children who have challenged the law.

For its civil investigation, the attorney general’s office sent Vanderbilt letters demanding information that dates back to 2014 at times. The letters, sent in November 2022 and this March, were filed with redactions in the federal court challenge of the gender-affirming care ban — though the documents state the office is investigating possible infractions under the Tennessee False Claims Act and the Tennessee Medicaid False Claims Act.

Known as “civil investigative demands,” the attorney general has sought numerous types of medical records for patients, in addition to billing and the submission of claims by the clinic to the state of Tennessee’s health plan, its Medicaid program and commercial insurers. They have also requested the names of everyone referred to the transgender clinic who at most underwent an initial office visit, without seeking further care there.

Furthermore, the medical center has been ordered to hand over information about the clinic’s employees, including doctors’ contracts, resumes, payment agreements and IRS tax forms. Notably, this has included emails from clinic workers, including about certain diagnoses regarding mental health and gender dysphoria, documents about the hospital’s Trans Buddy initiative, and information about Trans Buddy volunteers.

Democratic lawmakers have been quick to criticize the investigation, as well as its wide scope. Rep. John Ray Clemmons, a Democrat from Nashville, accused Skrmetti of “improperly weaponizing and abusing” his authority.

“Nowhere among the dozens of statutes in the Tennessee Code is there an authorization for the Attorney General to use taxpayer resources and his office to promote his own political agenda or that of his political party,” he said.

In Tennessee, the attorney general is appointed by the state’s Supreme Court.

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