The first year of the second Trump Administration has produced a series of directives that merge policy priorities with enforcement strategy. The False Claims Act (FCA) in particular has emerged as a preferred legal avenue for inducing government contractors and other recipients of federal funds, including those in the health care industry, to alter their practices.

Gender-affirming care for minors is a focus of the Administration's FCA enforcement efforts. In June 2025, Civil Division Assistant Attorney General Brett Shumate issued a memorandum (Shumate Memorandum) describing "Civil Division Enforcement Priorities." Echoing prior executive orders and statements by Attorney General Pam Bondi, the Shumate Memorandum reiterated the Civil Division's commitment to pursue FCA investigations related to gender affirming care and instructed the Civil Division to use "all available resources to prioritize investigations of doctors, hospitals, pharmaceutical companies, and other appropriate entities consistent with these directives." This includes "aggressive" pursuit of FCA claims "against health care providers that bill the federal government for impermissible services," such as "providers that attempt to evade state bans on gender dysphoria treatments by knowingly submitting claims to Medicaid with false diagnosis codes."

In the months since this directive issued, we've seen the DOJ ramp up investigative efforts into gender affirming care for minors with varying degrees of success. This summer, the DOJ issued more than 20 subpoenas to hospitals and clinics that provide gender-affirming care. Although the government has argued in response to motions to quash that the subpoenas were part of a legitimate investigation into violations of (among other things) the FCA, at least two courts have found the DOJ's reasoning pretextual. In the QueerDoc matter, a judge in the Western District of Washington found that the subpoena to QueerDoc was issued to "intimidate and coerce providers into abandoning lawful medical care", not to investigate health care fraud violations. The QueerDoc court reached this conclusion in part because of statements by DOJ leadership and the White House articulating the Administration's goal of "eliminating" gender-affirming care. A District of Massachusetts judge made similar findings in a matter related to a subpoena sent to Boston Children's Hospital. The close link between the Administration's policy aims and its FCA enforcement priorities may continue to prove a stumbling block as these matters reach the courts.

For more on this and other FCA-related issues impacting the health care and life sciences industries, please read the: