DOJ SECURES AGREEMENTS WITH NYU AND UPMC TO END PEDIATRIC GENDER-TRANSITION TREATMENT UNDER FEDERAL INVESTIGATION

WASHINGTON — September 18, 2026 — The Department of Justice announced agreements with New York University Langone Hospitals and the University of Pittsburgh Medical Center that resolve federal investigations into potential violations of law connected to medical interventions provided to minors for gender dysphoria and related conditions.

Under the agreements, NYU and UPMC will stop providing certain treatments to minors, including puberty blockers, cross-sex hormones, and surgical procedures covered by the settlements. NYU agreed to pay $8.5 million, while UPMC agreed to pay $950,000. The Justice Department said the resolutions arose from its nationwide investigation into whether hospitals violated federal health-care laws through the provision and billing of these procedures.

The Department uses the term “sex-rejecting procedures” in its enforcement actions, while many medical institutions and professional organizations have used the term “gender-affirming care.” The terminology itself is contested. For purposes of the federal agreements, DOJ defines the covered conduct through the specific medical interventions and billing practices addressed in its investigations rather than through terminology alone.

The federal claims resolved through the NYU and UPMC agreements remain allegations only. DOJ expressly stated that there has been no determination of liability, and both health systems have denied the allegations. That distinction is central to the legal status of the agreements: the hospitals have agreed to resolve the investigations and alter their practices, but the settlements do not constitute findings by a court that either institution violated federal law.

The Justice Department also credited NYU and UPMC for cooperation during the investigation. According to the Department, both institutions took steps that warranted cooperation credit and agreed to continue assisting with investigations involving other entities that may have violated federal law in connection with pediatric gender-transition treatment. DOJ described both systems as cooperative and solutions-driven throughout the process.

Attorney General Todd Blanche said the Department is continuing its effort to reach agreements with hospitals over pediatric gender-transition treatment and related billing practices. Assistant Attorney General Brett Shumate of the Civil Division said investigations into other providers remain active and that providers that have violated federal law without resolving their potential liability could face further enforcement action. U.S. Attorney Ryan Raybould for the Northern District of Texas said his office would continue following the evidence in related investigations involving minors.

The agreements are part of a broader federal enforcement initiative launched after President Donald Trump issued a January 2025 executive order directing the Justice Department to prioritize investigations and enforcement actions involving potential violations of federal law connected to pediatric gender-transition procedures. Attorney General Pam Bondi followed in April 2025 with a memorandum directing DOJ components to pursue potential Food, Drug, and Cosmetic Act and False Claims Act violations, including alleged misbranding and false billing.

The September 18 announcement builds on several earlier settlements reached during the same investigation. DOJ previously announced agreements with Texas Children’s Hospital, Cleveland Clinic Foundation, Connecticut Children’s Medical Center, and Mount Sinai Health System. Those institutions also agreed to stop providing specified gender-transition procedures to minors under the terms announced by the Department.

Texas Children’s Hospital became the first major institution to reach a resolution under the initiative in May 2026. DOJ said the hospital agreed to stop providing covered procedures to minors, pay more than $10 million in damages and civil penalties, and dedicate additional resources toward care for patients experiencing adverse consequences after earlier treatment. The Department stated in that case as well that the claims were allegations and that the entities involved denied liability.

Cleveland Clinic followed with a separate agreement involving a long-term commitment not to provide the procedures covered by that settlement to minors. Connecticut Children’s later entered into a similar resolution in August 2026. In September, Mount Sinai agreed to discontinue covered pediatric procedures and dedicate $2 million toward medical care for individuals reporting harmful consequences from treatment received as minors.

The Justice Department’s enforcement strategy has not been limited to negotiated settlements. In May 2026, the Department sought judicial enforcement of a subpoena issued to Rhode Island Hospital as part of an investigation into the distribution of puberty blockers and cross-sex hormones to minors with gender dysphoria and related conditions. DOJ said the hospital had not complied with the subpoena at the time of the filing.

The federal investigation is being coordinated through the Civil Division’s Enforcement and Affirmative Litigation Branch and Commercial Litigation Branch, Fraud Section, alongside the U.S. Attorney’s Office for the Northern District of Texas. The Department of Health and Human Services Office of Inspector General and the Food and Drug Administration Office of Criminal Investigations are also participating in the broader enforcement effort.

The investigations are being pursued through multiple federal authorities, including the False Claims Act, the Food, Drug, and Cosmetic Act, and other federal health-care laws, rather than through a single statute governing all such treatment nationwide.

The agreements with NYU and UPMC also demonstrate the financial dimension of the investigation. Together, the two institutions will pay $9.45 million under the announced resolutions. Those payments are separate from the operational commitments requiring the hospitals to stop providing the covered treatments to minors.

The policy environment surrounding pediatric gender-transition treatment remains highly contested. The current Justice Department characterizes the interventions as medically harmful and potentially unlawful in circumstances it is investigating. Medical providers and professional organizations have used different terminology and have disputed the federal government’s characterization of this field. The agreements announced September 18 resolve specific federal investigations and alleged legal exposure; they do not establish a nationwide judicial ruling on the medical validity of the treatments themselves.

The Department has made clear that the investigation is continuing.

For NYU and UPMC, the immediate result is concrete: both institutions have agreed to discontinue the covered pediatric procedures, make substantial payments, and cooperate further with federal investigators. For the broader health-care sector, the settlements indicate that DOJ intends to continue using the False Claims Act, federal drug law, health-care billing statutes, subpoenas, and negotiated agreements as central tools in its ongoing national enforcement campaign.

U.S. Department of Justice, Office of the Attorney General, “Preventing the Mutilation of American Children,” memorandum dated April 22, 2025. (Free Download)

The White House, “Protecting Children from Chemical and Surgical Mutilation,” Presidential Action issued January 28, 2025. (Free Download)

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