AG made sweeping demands for Vanderbilt transgender clinic records as part of fraud inquiry

Editors note: This story was updated Thursday to include an additional response from Vanderbilt University Medical Center.

 

New details about the state attorney general’s inquiry into gender-affirming care at Vanderbilt University Medical Center reveal a sweeping demand for 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.

Since November, Tennessee Attorney General Jonathan Skrmetti’s office has issued three demands seeking documents from the transgender health clinic as part of an ongoing investigation into possible violations of the Tennessee Medicaid False Claims Act, records filed in federal court show.

Parents of trans children ‘feel betrayed’ by Vanderbilt hospital

Those demands were not publicly known until this week.

Vanderbilt University patients, including parents of kids receiving care, were informed over the Juneteenth holiday weekend that “complete copies of patient medical records that are relevant to (the attorney general’s) investigation” had already been turned over.

Late Wednesday, a statement released by Skrmetti’s offices called the document demands part of a “run-of-the-mill fraud investigation.”

The demands 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.

The attorney general’s office is authorized under state law to issue the so-called civil investigative demands — document and testimony requests issued before any civil suit is filed. Medical records reviewed as part of an investigation into billing claims are kept confidential, the statement said. The statement also gave a nod to the public fallout since news of the document demands emerged.

“This office has kept the investigation confidential for almost a year and was surprised by VUMC’s decision to notify patients,” the statement said. “The Attorney General has no desire to turn a run-of-the-mill fraud investigation into a media circus.”

The statement did not address the office’s pursuit of records outside of billing and medical documents. It remains unknown the extent to which Vanderbilt has complied with additional document requests.

A spokesperson for Vanderbilt University Medical Center, responded after publication of this story to a question about whether the hospital system had complied with each and every demand for records from the attorney general.

“The short response to your question is ‘no,'” John Howser, the spokesperson said. Howser did not elaborate.

A ‘chilling effect’

The state’s demand for such a wide range of records on Vanderbilt’s transgender program “will have a chilling effect” on people seeking treatment, Chris Sanders, executive director of the LGBTQ-advocacy group, Tennessee Equality Project, said Wednesday.

“It is quite sweeping,” he said, noting it goes after several pieces of information that have nothing to do with a billing investigation. “That should be of concern to anybody who’s had dealings with the program.”

State Rep. John Ray Clemmons, D-Nashville, accused Skrmetti of using his office as a weapon and the powers of civil investigation demands to “carry out an intimidation campaign” against Vanderbilt, the state’s largest provider of transgender care.

Copies of demand letters were filed as part of an ongoing federal court challenge to the state’s newly enacted ban on transgender healthcare for minors.

The lawsuit was brought by transgender youth and families and later joined by the Department of Justice. A judge in that case is expected to shortly rule on a request to temporarily halt the law before it is set to take effect July 1.

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.

AG demands surface in federal lawsuit

State lawyers have argued there is no need for an immediate injunction because the law calls for a  temporary “wind down” period allowing existing transgender patient care until March 2024.  Lawyers for the families, however, have noted the law threatens children needing care with “imminent and irreprable injury.”

Vanderbilt University Medical Center has already informed the families filing suit that it will cease providing care July 1 unless the law is enjoined, the lawsuit noted.  Doctors providing care are fearful that they would be “second-guessed by state officials during the wind down period,” court filings said.

“In light of how the Attorney General’s office has targeted VUMC for legal investigation, these fears are well founded,” lawyers for the family noted in a filing.

The demands for patient health information, first reported by The Tennessean, began on Nov. 2 with a civil investigative demand seeking medical records dating back to 2018 for more than 80 patients, whose names are redacted in the request.

State and federal laws allow for the attorney general to demand otherwise protected health information as part of the investigative process.

Tennessee law specifically gives the attorney general’s office authority to issue civil investigative demands for testimony and documents before filing a lawsuit. Those demands may be contested, narrowed through negotiation or challenged in court — an event that could open the door to individuals with a stake in the records to intervene before they are provided.

Vanderbilt officials have declined to respond to questions about whether they pursued any other option before turning over records. In messages to patients and parents, the medical center said it was legally obligated to turn over medical records.

A wide net

A second demand on March 14 sought the medical records of over 100 patients. The demand also sought a variety of information about insurance claims submitted to state-sponsored health plans, along with emails, training materials and other documents related to the clinic’s policies for submitting claims.

A third demand, also issued March 14, cast a far wider net.

Among the information it sought dating to 2014, were names of all individuals referred to the Center for Transgender Health who ultimately did not receive gender affirming care. It also sought the resumes, contracts and other documents for volunteers at the center’s Trans Buddy program, which provides peer support from students, staff, and community members.

The demand also included all communication to and from an email inbox set up to answer questions about LGBTQ healthcare; and all communications between a Vanderbilt clinical psychologist and staff at Centerstone, a nonprofit mental health clinic, related to “potential gender dysphoria diagnosis” of a Centerstone patient

Sanders, the LGBTQ advocate, pointed out Vanderbilt hospital opened the transgender care unit in part because the LGBTQ community faces health-care barriers. Now that it’s being “targeted” by the state government, another hurdle could prevent people from seeking care, he said.

“It will make people think twice about seeking health care, because if you thought that the government was gonna routinely request everything related to a particular group’s health care, you would be really cautious,” Sanders said.

Vanderbilt’s transgender healthcare practices drew attention last year after right-wing commentator Matt Walsh posted videos on social media featuring a Vanderbilt physician calling gender transition surgery a “big money maker,” causing backlash against the hospital from Republican lawmakers.

Sanders believes the Attorney General’s Office investigation stems partially from that social media firestorm. Elected officials are feeling pressure from the “far right,” as well, to take action, he said.

Sanders ventured so far as to say emails he’s exchanged through advocacy work with the Vanderbilt hospital program could be caught up in the attorney general’s probe.

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