So what the other whistleblower in Texas had begun to expose is doctors using potentially fraudulent billing codes as a way to bypass scrutiny from state and federal authorities. So what I mean by that is there were a few lawsuits that were filed by Ken Paxton over the past year, three of them, and in one against Dr. Cooper… It was for the violation of SB 14.
When you read the lawsuit, it describes the alleged scheme, and what they would do is they would have a patient who would come in, maybe a 16-year-old girl. And because of SB 14 being passed in Texas, it was now illegal. But how could they continue quote-unquote, gender-affirming care? How could they get these hormones prescribed but still get paid for it, or the blockers prescribed and still get paid?
So what they would do, a 16-year-old girl comes into the clinic, right? Believes she's a boy. They would change the sex on the medical chart, which is really easy, because Epic, which is a big healthcare medical system, has instituted this thing called the gender and sexual identity smart form [sic, Sexual Orientation and Gender Identity (SOGI) SmartForm] where anyone can change the sex of the patient. So on the chart, it says male. And then for the diagnosis, they write testosterone deficiency. There may not be any kind of diagnostic evidence of testosterone deficiency, but that's what they list on the code.
So when those two things go to the insurance companies—the diagnosis, testosterone deficiency, and then the treatment, the CPT code, which is testosterone supplements—the 16-year-old girl gets the testosterone paid for, right from the pharmacy. The doctor gets paid. Insurance companies or Medicaid or Medicare don't know they're getting scammed, and we all don't know we're getting scammed. We're taxpayers.
So that's what I believe is going on at all these hospitals, because if you Google on your phone, right, gender-affirming care diagnosis codes, the fourth thing you'll find is, like the Southern Equality Law Center, right? It's like some activist organization. They have all the diagnosis codes you can use to fraudulently bill insurance companies. It's like an online guide for how to commit felony medical fraud and get away with it. It's like an online guide for cooking meth or explosive devices—like a top Google search. So that is, I think, the new frontier. But because this information is identifiable with information we have at hand, because the Do No Harm database, the Stop the Harm database was using all of this insurance data, ICD codes, doctors, and CPT codes in order to link procedures, if you were to set a certain time, January 20, 2025, before and after, and look at certain doctors, if there's an increase in a certain number of diagnosis codes, then you can pretty much guarantee you've just identified a healthcare scam.
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