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AG Ken Paxton Opens Investigation Into Medicaid Fraud At Texas Children's Hospital

AG Ken Paxton Opens Investigation Into Medicaid Fraud At Texas Children's Hospital

Texas Attorney General Ken Paxton has opened an investigation into Texas Children's Hospital (TCH) for alleged Medicaid fraud regarding medical gender transitions performed on minors.

Activist and journalist Christopher Rufo, who has previously reported on TCH's "gender-affirming care" for minors, reported on the alleged Medicaid fraud at the hospital in a Tuesday article for City Journal.

Doctors Richard Ogden Roberts and David Paul were allegedly willing to defy Texas law by falsifying medical records in order to practice "gender-affirming care" on minor patients, according to surgeon Eithan Haim and nurse Vanessa Sivadge, per Rufo's report.

Roberts, Paul, and TCH did not respond to Rufo's request for comment prior to the publication of his report.

Sivadge, who anonymously spoke with Rufo in May of 2023, revealed Roberts had encouraged minor patients to undergo medical gender transition, arguing there was no "critical analysis" to his diagnosis.

“I work very closely with this provider, Dr. Richard Roberts. I’ve been in the room with him when he speaks with these patients,” Sivadge said at the time. “Dr. Roberts is extremely encouraging of their transition and will essentially do whatever he can to make sure that they are happy, at least externally happy. Because I am absolutely certain that they are not internally happy. He is very accommodating. He does whatever they want. Essentially, there is no critical analysis of the process.”

Shortly after speaking with Rufo, Sivadge said FBI agents Paul Nixon and David McBride showed up to her home to discuss "some of the things that have been going on at [her] work lately." Nixon and McBride reportedly told Sivadge she was a "person of interest" who had allegedly violated federal privacy laws.

"They threatened me," Sivadge told Rufo. "They promised they would make life difficult for me if I was trying to protect the leaker. They said I was ‘not safe’ at work and claimed that someone at my workplace had given my name to the FBI.”

After the FBI visited her, Sivadge noticed other discrepancies in paperwork and surmised doctors had in fact been violating Texas law, which prevents Medicaid from being billed for medical gender transition procedures. Sivadge reported patients receiving "gender-affirming care" were enrolled in TCH's Health Plan STAR, which is described as a "no-cost Medicaid managed care plan."

“Based on the facts we have, the only reasonable conclusion is that Texas Children’s Hospital was using Texas Medicaid funds to pay for ‘gender-affirming care,’ contrary to Texas law,” said one legal expert, per Rufo's report.

Last May, Haim, who also originally spoke under the condition of anonymity, sent records to Rufo proving the hospital continued providing medical gender transitions for minors after publicly stating they would cease their procedures.

Haim, who was reportedly threatened with legal consequences by federal prosecutor Tina Ansari, was also visited by three "heavily armed federal agents" who gave the surgeon a summons earlier this month. Haim was indicted on four felony counts of violating medical privacy laws, according to Rufo, and faces up to ten years in federal prison. Haim reportedly redacted patients’ names and identifying info to protect their privacy and avoid potentially violating HIPAA laws.

“The four-count indictment alleges Haim obtained personal information including patient names, treatment codes and the attending physician from Texas Children’s Hospital’s (TCH) electronic system without authorization,” wrote Southern District of Texas's chief law enforcement officer Alamadar S. Hamdani in a statement. “He allegedly obtained this information under false pretenses and with intent to cause malicious harm to TCH.”

Shortly after the latest report was published, a spokesman for Paxton announced the attorney general had opened an investigation into the hospital for alleged Medicaid fraud.

“My faith and my gut, just knowing right from wrong, compels me,” Sivadge told Rufo. “I was born for this. I have no doubt this is what I am supposed to do.”

The nurse went on to describe what she witnessed and unknowingly participated in as "deeds of evil and darkness."

“I was told to do something I knew was wrong,” she said. “It made me sick that the lie called ‘gender-affirming care’ was being sold to parents and children and creating hugely lucrative profits in secret—and I was part of it.”

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