Just two days after finalizing a regulation to make sure trans kids from low-income families can’t afford puberty blockers or hormone therapy, the Trump administration has loosed another salvo in its bitter war against transgender people’s healthcare. On Thursday, the Department of Health and Human Services published a report—authored largely by employees of right-wing advocacy groups—alleging that some hospitals are using incorrect codes to bill insurance for pediatric gender-affirming care. The report paints transgender healthcare as motivated by profit rather than medical necessity, calling the billing codes “potentially fraudulent.”

In a social media video, Vice President JD Vance announced he was referring roughly 150 healthcare organizations listed in the report to the Department of Justice for criminal investigation. The list includes over a dozen major children’s hospitals, pharmacies including Walgreens, and small doctors offices and clinics. Standing at Vance’s side, HHS Secretary RFK Jr. added that he, too, was referring the providers for investigation by his department’s inspector general.

“It’s an intimidation campaign.”

Yet advocates of transgender healthcare describe the HHS report released Thursday as part of a larger effort to shut down care. “This report is part of a broader pattern from this administration: Using the power of government to attack science and target health care providers instead of helping families get the care they need,” says Kellan Baker, senior advisor for health policy at the Movement Advancement Project. “It’s an intimidation campaign,” adds Jennifer Levi, the director of transgender and queer rights at GLBTQ Legal Advocates & Defenders, pointing to ways the report might show up in future legal cases.

The HHS report—provocatively titled “Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of ‘Gender Medicine‘”—lambasts doctors’ use of two diagnostic codes........

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