Tennessee AG Just Needs Trans Kids' Medical Records To Fight, Umm, 'Billing Fraud,' Yeah That's It

The real scandal is that kids' parents found out.

Parents of trans kids in Tennessee are somewhat discomfited over news that the office of state Attorney General Jonathan Skrmetti [sic] is examining patient records from Vanderbilt University Medical Center's transgender clinic. The AG's office says there's nothing to worry about, and that it's simply investigating whether Vanderbilt somehow did fraud when billing for care at the clinic, and don't be silly, the state will respect patients' privacy and is only looking into whether the hospital's Center for Transgender Health did bad things. In fact, if anyone has behaved badly here, the AG's chief of staff insisted, it's Vanderbilt, for even notifying parents that the hospital turned over records to investigators. No fair! It was a secret! 

The AG's office confirmed to the Nashville Tennessean Tuesday it's investigating billing fraud, but went into little detail. Vanderbilt sent notices to parents and patients to inform them that the records had been turned over to the state. The Tennessean reports it

reviewed a VUMC notice informing patients of the move, which the facility said was the result of an investigation into "billing for transgender care services provided to individuals enrolled in State-sponsored insurance plans." The state requested medical records from Jan. 1, 2018 to the present.

The attorney general's office said VUMC began providing relevant records in December 2022, and the state's investigation is focused on the facility and certain providers, not patients.

The state does have legal authority to request patient records as part of such investigations, the paper reports, but it adds that families whose kids attended the transgender clinic are nonetheless worried because Tennessee, like many other red states, is in the midst of a full-on rightwing culture war against trans people.

The state Lege passed a ban on gender-affirming care that will go into effect on July 1 unless it's blocked by one of several lawsuits before then (more on that later), and the Vanderbilt clinic was last fall the focus of rightwing media panic fomented by stochastic terrorist Matt Walsh . Walsh claimed that medical staff at Vanderbilt "castrate, sterilize, and mutilate minors as well as adults,” which led to widespread threats and calls by lawmakers for the clinic to be investigated, if not literally burned to the ground.

So yeah, you can see why parents might worry a bit about what the state might be looking for in their families' medical records, although the notices VUMC sent to families noted that the records were given to the state with the AG office's "assurance that the records would remain confidential as required by Tennessee law."

In an emailed statement, AG Chief of Staff Brandon Smith told the Tennessean that the real scandal is that the hospital narced on the AG's office, shame on VUMC.

We are surprised that VUMC has deliberately chosen to frighten its patients like this. [...]

The Office does not publicize fraud investigations to preserve the integrity of the investigative process. The Office maintains patient records in the strictest confidence, as required by law. The investigation is focused solely on VUMC and certain related providers, not patients, as VUMC is well aware.

The statement added that the AG's office has been "investigating potential medical billing fraud by VUMC and certain related providers since September 2022." Gosh, by complete coincidence, that's the very same month Matt Walsh took up his crusade against Vanderbilt's gender clinic.

A followup statement Thursday said the document demands from the AG

were prompted by a report his office received in the summer of 2022 that a Vanderbilt doctor “publicly described her manipulation of medical billing codes to evade coverage limitations on gender-related treatment,” the statement said. That led to the start of investigation last September into potential fraudulent billing violations involving Vanderbilt and “certain related providers”, the release said.

Golly, where did that "report" come from?

For some reason, families of trans kids don't seem to recognize the entirely benign intentions of the state government, which seeks to deny their children medical care and force them to undergo puberty as the gender they do not identify with. 

Gosh, they're so distrustful, as the Tennessean reports:  

Chris Sanders, executive director of the Tennessee Equality Project, an LGBTQ advocacy organization, said three different parents of transgender children called him in a panic since Monday after they were told by Vanderbilt that their child’s medical records were released to the attorney general as “part of an investigation.”

Sanders said the parents had no other details.

“They’re terrified,” he said. “They don’t know what’s next, they don’t know how this will be used or whether they will be targeted in some way. They feel like their privacy has been violated.”

On top of all that, we learned Thursday that according to court records, AG Skrmetti's office sought a far wider range of information from Vanderbilt, seeking

documents at all levels of care, from patient records to volunteers’ resumes, communications with outside therapists and emails sent by members of the general public to an LGBTQ health questions portal.

The state inquiry has also sought the names of any persons referred to Vanderbilt for transgender care for nearly a decade who opted not to pursue care.

That's a funny way to run a billing fraud investigation!

The story in the Tennessee Lookout notes that it's not clear whether Vanderbilt complied with the requests for materials that went beyond patient records. Copies of the demand letters were included as part of a lawsuit seeking to overturn the new ban on gender-affirming care, which was brought the ACLU on behalf of families of trans kids and later joined by the US Department of Justice. A decision on whether to block enforcement of the law is expected before the law goes into effect July 1. Given recent decisions blocking anti-trans hate laws around Red America, that seems, dare we say it, likely. But it's 2023, who knows?

The Lookout explains that

In seeking a preliminary injunction putting the law on pause while the legal case continues, lawyers for the families introduced the attorney general’s demand letters as evidence of the immediate harm the impending ban will have without court intervention.

The lawsuit says VUMC has notified parents that if there's no injunction, it will have to end gender-affirming care on July 1, although the law generously allows treatment to "wind down" for existing patients until March of 2024.

For a complete list of all the documents the AG's office requested, in insane detail — they wanted every IRS form going back to 2015 for all doctors at VUMC's transgender clinic, for starters — see the Tennessean, which first broke the story. This weirdness seems to be just getting started, and it looks hinky as fuck.

[ Tennessean / Tennessee Lookout / Tennessee Lookout / Tennessean ]

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