Vanderbilt University Medical Center is facing a federal civil rights investigation for turning over the medical records of more than 100 transgender patients to the state’s Republican attorney general.

The U.S. Department of Health and Human Services’ Office for Civil Rights launched the investigation in response to a lawsuit in which two of those patients sued the hospital for releasing their records to Attorney General Jonathan Skrmetti last year.

The patients argue that VUMC should have removed personally-identifying information before turning over the records because it should have been aware of Tennessee state officials’ hostile attitude towards transgender people, based on several anti-LGBTQ measures that have been passed into law in the state.

These include a ban on gender-affirming care, restrictions on transgender participation in sports, and a ban on “adult-oriented” performances intended to restrict public displays of drag or gender-nonconformity.

All 106 patients whose private medical information was shared with the attorney general’s office are covered by some form of state insurance plan. However, the lawsuit alleges that some of those who had their information shared without permission were not even patients at VUMC’s clinic specializing in transgender care.

“The more we learn about the breadth of the deeply personal information that VUMC disclosed, the more horrified we are,” attorney Tricia Herzfel, who is representing the patients in the lawsuit. “Our clients are encouraged that the federal government is looking into what happened here.”

The hospital previously received criticism for waiting months before telling patients in June that their medical information had been shared with the attorney general’s office in December 2022.

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That revelation only came to light after the attorney general confirmed receipt of the records as part of a separate case. After receiving the records, the attorney general’s office launched yet another probe looking into another doctor at VUMC.

A spokesperson for VUMC confirmed that HHS had begun an investigation into whether the hospital had violated patients’ privacy.

“We have been contacted by and are working with the Office of Civil Rights,” spokesperson John Howser said in a statement. “We have no further comment since this is an ongoing investigation.”

Under the federal Health Insurance Portability and Accountability Act of 1996, healthcare providers may — but are not required to — disclose patients’ medical records for law enforcement purposes in certain circumstances, such as in response to an administrative request if the information being sought is relevant to a legitimate law enforcement investigation.

Both Vanderbilt University Medical Center and Skrmetti’s office claim the hand-off of patient information was legal, and in line with an investigation that was launched last year after a doctor at the hospital described, in a video from 2018, how she will sometimes manipulate medical billing codes to avoid insurance exclusions or coverage limitations on gender-affirming treatments.

“For the patient who gets a big bill because their insurance doesn’t cover any transgender-related codes, I usually write ‘endocrine disorder – not otherwise specified’ to allow me to order the labs that I want,” Dr. Shayne Sebold Taylor says in the video.

Skrmetti, in an interview with WTVF earlier this month, claimed that such actions constitute “fraud.”

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Skrmetti defended his office’s investigation into that alleged “fraud,” for which he needed access to the records of people who had undergone gender-affirming care to see if similar manipulations of billing codes had occurred at VUMC’s transgender clinic.

“It’s not a question of trying to use these names for the purpose of going after individuals. The purpose is to link up the medical records to the billing records to determine whether anything inappropriate happened,” he told WTVF.

To critics, the timing of Skrmetti’s request for records last year was suspect, coming on the heels of demands from Republican lawmakers and Republican Gov. Bill Lee to investigate the practices of VUMC’s transgender clinic after right-wing outlets trumpeted comments by Taylor suggesting that gender-affirming surgeries can be “huge money makers.”

While acknowledging that his actions may seem political, Skrmetti insisted that his investigation focuses on hospital staff who may have engaged in wrongdoing, not on transgender individuals receiving care or their families. He claimed he would have pursued the investigation, even had the doctors in question not been providers of gender-affirming care.

Skrmetti said he empathized with concerns by patients — including those suing Vanderbilt over the sharing of records — who may believe they are being targeted.

“I think it’s probably terrifying right now,” he said. “[The patients] are being told this is for a nefarious purpose. I get it, but there is no political exception to the fraud laws.”

When asked if he could assure parents of transgender youth that their medical records would not be used to prosecute parents for “child abuse” if they sought out gender-affirming care for their trans-identifying children, Skrmetti responded, “Absolutely. There’s no possible way they could be used for that purpose.”

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While agreeing with the statement that gender dysphoria is a legitimate medical issue, Skrmetti also stood by his belief that the state legislature has the right to pass laws restricting access to gender-affirming care if they believe such treatments are overprescribed, too easily accessible without sufficient safeguards, or may do harm to patients in the long run.

“It’s hard out there for transgender people, and I don’t want to persecute them,” he said. “I just want to make sure that our laws are enforced in the appropriate constitutional way.”

He also pushed back against assertions that he is anti-LGBTQ, noting that when he was a federal prosecutor more than a decade ago, he prosecuted a Memphis police officer who savagely beat a transgender woman.

But Democratic lawmakers and LGBTQ advocates are skeptical of his motives, noting that Skrmetti had joined 18 other attorneys in voicing opposition to a proposed HHS rule that would restrict state officials from accessing the medical records of people who cross state lines to obtain reproductive health care services that would not be available in their home states.

Skrmetti is also defending the state’s ban on gender-affirming care for transgender minors in court, and praised a recent federal appeals court decision allowing the law to take effect.

Shortly after the news of Vanderbilt’s sharing of private medical records broke, State Rep. John Ray Clemmons (D-Nashville) accused the attorney general of “improperly weaponizing and abusing” his authority.

“Nowhere among the dozens of statutes in the Tennessee Code is there an authorization for the Attorney General to use taxpayer resources and his office to promote his own political agenda or that of his political party,” Clemmons said.