Benjamin Ryan
@benryanwriter • 51,042 subscribers
Independent investigative journalist Contact via Signal: benryan.23 Subscribe: https://t.co/dQRHZHqWHn
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In WPATH's Own Videos, Doctors Describe Billing Gender-Transition Care Under Alternative Diagnoses A psychiatrist called switching to "unspecified endocrine disorder" a way to "work around" the system. A Utah OB-GYN said she billed that way for 14 years. The Trump administration calls such coding fraud. When New York City’s Mt. Sinai Health System reached a settlement with the Justice Department last week to keep its pediatric gender clinic closed, much of the public debate over why the hospital had capitulated focused on the Trump administration’s efforts to obtain patient records via subpoena. This overlooked the mounting efforts by Republican lawmakers more broadly and the Trump administration in particular to leverage accusations of fraudulent medical billing to target doctors in this field and drum them out of providing gender-transition interventions to minors. A spokesperson for Mt. Sinai said last week: “The settlement is complex, but at its core reflects Mount Sinai’s commitment to safeguarding our patients’ confidential information and protecting our clinicians.” Those last few words, protecting our clinicians, at least theoretically could refer to protecting clinicians from prosecution or civil lawsuits for the use of non-gender-identity-related diagnosis and procedure codes when seeking reimbursement for puberty blockers, cross-sex hormones or gender-transition surgeries to treat gender dysphoria in minors. Last year, I obtained several hundred videos from conferences held by the World Professional Association for Transgender Health and its US affiliate, USPATH, between 2021 and 2023. These videos were subject to a subpoena by the Alabama attorney general, Steve Marshall, as part of his defense in a lawsuit against the state’s ban on gender-transition interventions for minors. I covered how these videos portrayed the besieged field of pediatric gender medicine in a report for Compact magazine earlier this year and have been serially publishing key videos on my Substack since then. I have newly scoured these videos for conference speakers addressing the use of alternative procedure or diagnosis coding in transgender care. I found a number of examples, video clips of which I have published and analyzed below. None of them included speakers specifically referring to minors in the moments when they made such references to coding choices, mind you. But in at least some cases, the wider context of their presentations or their response to audience questions did not rule out that minors could be included in what they were suggesting or recalling about coding practices. In American medicine, physicians use diagnosis codes from the ICD system, which specify the condition being treated, and procedure codes known as CPT codes, which indicate the actions the physician took to treat the condition. These codes are integral to obtaining reimbursement for services. Insurers require diagnosis codes to serve as an appropriate justification for the corresponding procedure. The U.S. Department of Health and Human Services on Aug. 13 published a scathing report bearing the incendiary title “Wolves In White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of ‘Gender Medicine.’” Much of the report is devoted to examining how leaders in pediatric gender medicine advocate the use of alternate codes when seeking insurance reimbursement for gender-transition interventions. These practices, the report asserts, have become widespread in this field. The report serves as an ominous warning to health care providers still practicing in what remains of a field that the Trump administration has seen considerable success in destroying outright. “When healthcare providers use fraudulent medical coding to obtain payment from the federal government,” the HHS report asserts, “they may be liable under the federal False Claims Act, which carries fines and imposes damages of ‘3 times the amount of damages which the government sustains.’” To follow federal regulations, the report asserts, physicians treating patients for transgender-related purposes are meant to use a number of ICD diagnosis codes related to gender identity, sex reassignment or “dual role transvestism.” But it has become common for medical providers to use alternate diagnosis codes, according to the report—in particular those related to endocrine disorders. This includes, the report states: “Endocrine disorder, unspecified,” coded as E34.9. Using this code in place of a gender-related diagnosis (e.g., gender identity disorder, F64.0) violates CMS guidelines for the simple reason that gender dysphoria is not an endocrine disorder, since it exhibits no hormonal abnormalities. In fact, the only endocrine disorders these patients have are the ones created by their doctors through the use of sex-rejecting interventions. Yet it appears that healthcare providers are misusing this code. In a 2016 studytitled “Identifying the Transgender Population in the Medicare Program,” CMS’s Office of Minority Health acknowledged that proxy diagnosis codes are being substituted for gender dysphoria. In the methods section, the authors explain that they included the ICD-9 diagnosis code for Unspecified Endocrine Disorder in their analysis because it is “frequently used by the transgender community to combat the perceived stigma of a GID diagnosis.” The report goes on to note that a 2023 study also finds such use of alternative billing codes. The report further notes an analysis of medical-claims data by Leor Sapir, a senior fellow at the Manhattan Institute who studies pediatric gender medicine, that found an almost 30 percent increase in endocrine disorder, unspecified diagnoses in minors between 2020 and 2022. Dr. Sapir asserted in 2025 that this was likely the product of a “greater willingness” by medical providers to use endocrine disorder codes over gender identity disorder codes in pediatric care of patients with gender dysphoria. The authors of the HHS report analyzed health insurance databases covering 2015 to 2025 and found that insurers were billed nearly $50 million for puberty blockers for patients age nine to 17 under endocrine disorder codes, excluding precocious puberty. There was nearly $11 million in billing for 13- to 17-year-olds using a precocious puberty diagnosis code. The report asserts that “this data strongly suggests a pattern of potentially fraudulent billing that relies on miscoding for endocrine disorders to justify the prescription of puberty blockers.” WPATH, the report goes on to state, has promoted “the misleading use of several ICD-10 codes” in its training presentations. Teddy Goetz Dr. Teddy Goetz is a psychiatrist who currently works at the Mid-Atlantic Permanente Medical Group. Dr. Goetz, who identifies as nonbinary, was a coeditor of a controversial text put out by the American Psychiatric Association’s publishing arm in 2023 outlining how to apply the gender-affirming method to the care of what these days are known as gender-expansive patients. Dr. Goetz spoke at USPATH’s 2021 conference. The moderator, taking an audience question, asked about how to move away from a distress-based model of care for transgender patients, in which it is required that they harbor distress related to their gender identity to qualify for a diagnosis that will justify gender-transition treatment. “We can think about it in the terms of billing codes,” Dr. Goetz replied. When a patient first presents, Dr. Goetz said, a doctor could use a gender dysphoria-related billing code to process a prescription for gender-transition treatment such as testosterone. But if this treatment ultimately attenuates the patient’s dysphoria, Dr. Goetz said, “Then you could switch your billing code to ‘unspecified endocrine disorder,’ for example, saying that their body produces less testosterone than it should for them to feel their best. So there are different ways that you can work around that. And thinking about moving towards euphoria and away from dysphoria.” Addressing a common conundrum that expands well beyond transgender medicine, Dr. Goetz continued: “But our current health care system in the United States is really set up against a preventive health care model and towards more of a responding-to-active-problems model.” It remained unclear whether Dr. Goetz was referring to treating pediatric patients when describing these billing practices. What is evident, however, is that Dr. Goetz, who at the time was a medical resident at the University of Pennsylvania, was then working at least part of the time at a children’s hospital. At one point during the conference session, Dr. Goetz made a specific reference to “the children’s hospital where I do work in addition to the adult hospital.” A spokesperson for Kaiser Permanente provided me a statement indicating that “We understand” that Dr. Goetz “was speaking hypothetically” at the conference. “Dr. Goetz is an adult psychiatrist and does not provide care to, nor prescribe puberty blockers or hormone therapy to Kaiser Permanente pediatric patients,” the statement continued.
Benjamin Ryan22,825 次观看 • 1 天前
British TV Show Rewarded Jason Arday After Being Told Tales of His Fundraising in 2012 I have obtained this recording of a 2012 episode of the British TV show "Surprise Surprise." In it, Jason Arday's then-partner, later wife Debbie McKenzie tells the host he didn't learn to read until 16; Arday has long claimed he was 18, but doesn't correct her on the show. She also claims he, at 27, had raised £250,000. We now know this is almost certainly false. Asked by the host why he does such nice things for people, a bashful Arday says: "There's people that do amazing things day in and day out, and I'm just fortunate enough that I'm surrounded by people who appreciate it." To reward what almost certainly were falsehoods on Arday's part (it is unclear whether McKenzie knew he had not raised all that money), the TV show pledged to send him to New York to watch the marathon (which was canceled that year due to Hurricane Sandy). They also sent him to see Andy Murray play and to meet the tennis legend. One might argue that by receiving material goods in exchange for falsehoods, Arday had committed fraud. Murray later marveled over Arday's story to the Guardian, in particular Arday's claim, likely false, that he ran the last 10 marathons with a hairline fracture in his leg. In the mid-2010s, Arday applied for a university job. I obtained his application, in which he claimed that Murray supported his fundraising. I asked a representative for Murray if this were true and they said they had no record of the quote tweet.
Benjamin Ryan962,755 次观看 • 1 个月前
Easily the finest opening credits of a film in the history of cinema:
Benjamin Ryan1,233,273 次观看 • 2 个月前
In which activist members of the University and College Union, Britain's largest higher-ed union, redefined plagiarism to exclude textual overlap. They apparently thought at this meeting on Tues that Arday was only accused of this. But he was accused of stealing data as well.
Benjamin Ryan20,927 次观看 • 22 天前
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OHSU Performed Vaginoplasties On 17 Year Olds Oregon Health & Science University urologist Dr. Geolani Dy said that for “a lot” of the hospital’s young patients, the timing of a vaginoplasty (a surgery that includes castration) “will fall around the seventeen-, eighteen-year-old age range.” Dr. Dy said this during a presentation at the 2021 conference of the US offshoot of the World Professional Association for Transgender Health, USPATH. See the main post in the thread for my article in Compact and my companion post with dozens of clips like this one.
Benjamin Ryan44,090 次观看 • 5 个月前
Dr. Natasha Johnson, a pediatrician at McMaster University, has become president of the Canadian Paediatric Society. Dr. Johnson said at a 2022 WPATH conference that "parents' feelings" about their child's medicalized gender transition "should not be prioritized over the youth’s experience.” In other words, she argued for discounting parental objections to prescribing their children puberty blockers and cross-sex hormones to treat gender dysphoria. Dr. Johnson was instrumental in stirring up the protests against the recent systematic reviews of pediatric gender medicine out of Dr. Gordon Guyatt's lab. These protests ultimately led Dr. Guyatt and some of his colleagues to denounce their funder, the Society for Evidence Based Gender Medicine SEGM, and seek to pull their names off of pending review papers, putting them in limbo. More on the WPATH videos here: More on the McMaster protests here:
Benjamin Ryan24,666 次观看 • 3 个月前
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Taylor Lorenz spent 16 hours a day online starting in college Referring to herself as the "oldest person on the beat," internet-youth-culture reporter Taylor Lorenz says she and the interviewer are "both millennials in our 30s" and that she became obsessed with the internet in college in the late 2000s. Tumblr was her "gateway," she says, leading to 16 hours a day on the internet. This compared with her life at her parents house as a child where she was only allowed 45 minutes of internet a day.
Benjamin Ryan32,658 次观看 • 6 个月前
The Boston conference panel featuring four skeptics of pediatric gender medicine went off this morning with minimal disruptions. I obtained video and audio of the surrounding protests, one of the disruptions from a WPATH leader, and the moderator, Dr. Rauch, introducing the panel. I've dropped all of that into an update to this Substack I published on Friday if you want to take a look: Otherwise, the videos are below. They feature: *Protests outside the conference hall, including a marching band. *Kale Edmiston, a neuroscientist by training and a coauthor of one of the chapters of WPATH’s Standards of Care, disrupting the panel and interfacing with the panelists. *A protester being dragged away.
Benjamin Ryan25,893 次观看 • 4 个月前
Kellan Baker counseled against saying “gender-affirming care.” Messaging research indicated that when people hear it, he said, “they think ‘trans kids in the driver’s seat.’” But he said this was an accurate assessment. “I think we all support trans kids in the driver’s seat because it’s their bodies, it’s their lives,” he said. “But when you think about folks who don’t know trans people, they are very scared by the idea that young people are making irreversible decisions and that no one else has any oversight over those decisions.” To read my article in Compact about the 100s of videos I obtained from the World Professional Association for Transgender Health (WPATH) and its US offshoot, USPATH: I will be publishing the most notable conference videos on my Subsack:
Benjamin Ryan25,823 次观看 • 5 个月前
On CBS News, I reported on the $2M judgment in the 1st detransitioner civil suit to go to trial. I recalled the mother saying her daughter’s psychologist browbeat her into consenting to a gender-transition mastectomy for the 16 year old. But then the president-elect of WPATH testified that such surgeries, in fact, are not a form of suicide prevention, full stop.
Benjamin Ryan31,584 次观看 • 7 个月前
Internet-culture reporter Taylor Lorenz insists the advent of smartphone-based social media did not cause the soaring rates of youth mental illness post 2012. She points instead to structural economic and political factors, including the Great Recession and opioid addiction in parents. Taylor Lorenz, who has made evident through her recent statements and actions that she is an aspiring influencer, insists Jonathan Haidt has stirred a moral panic over smartphones. She previously insisted in an unpaid promo she posted and later deleted for The Bark Phone that smartphones are good for kids because they provide them a way to express themselves.
Benjamin Ryan23,747 次观看 • 6 个月前
“Any form of ageism is unethical,” Simona Giordano, a bioethicist at the Univ of Manchester and WPATH ethics committee member, said in 2022 regarding providing gender-transition interventions to minors. “Refusing to treat someone because they are too young is as unjust as refusing to treat someone because they are too old. Decisions shouldn’t be based on age, but on capacity to benefit from treatment.” To read my article in Compact about the 100s of videos I obtained from the World Professional Association for Transgender Health (WPATH) and its US offshoot, USPATH, scroll up.
Benjamin Ryan19,205 次观看 • 5 个月前
Johanna Olson-Kennedy: “I think that a lot of this conversation...gets talked about through a lens of ‘How can we make sure people are really trans,’ right? And ‘They’re not going to regret their decision later?’” But “that’s actually not the discussion that I’m interested in participating in," she said. "I’m interested in discussing and having a conversation about giving the very best possible care to trans young people—the care that they need and deserve.” To read my article in Compact about the 100s of videos I obtained from the World Professional Association for Transgender Health (WPATH) and its US offshoot, USPATH: I will be publishing the most notable conference videos on my Subsack:
Benjamin Ryan18,866 次观看 • 5 个月前