The Cleveland Clinic has reached a federal settlement that includes a $2 million commitment toward what officials describe as care for individuals who later seek treatment after discontinuing gender-related medical interventions received as minors.
The agreement follows a Department of Justice (DOJ) investigation into billing practices tied to gender-related medical procedures performed on minors, including allegations that Medicaid claims contained inaccurate coding related to treatment classifications.
The hospital will also pay $308,000 to resolve additional federal and state billing allegations.
Under the terms of the settlement, the Cleveland Clinic agreed to a 20-year restriction on most gender-related medical procedures, including surgeries, for minors across multiple facilities in Ohio and other domestic and international locations, according to Signal Cleveland.
Federal officials said the agreement is intended to ensure continued services for individuals who experience regret or complications following prior medical interventions, framing the provision as part of follow-up care obligations tied to the settlement.
Hospital officials said the agreement does not represent a major operational shift, arguing that Ohio law already restricts such procedures for minors and that the settlement largely reflects existing compliance requirements rather than new policy changes.
Cleveland Clinic spokeswoman Angela Kiska described the matter as a billing classification issue involving a limited number of cases and said the institution denies any intentional wrongdoing.
The hospital confirmed that gender-related medical care for adults will continue unchanged under the agreement.
According to settlement documents, federal officials alleged the hospital used incorrect diagnosis codes in Medicaid billing submissions in a way that obscured the underlying reason for certain treatments.
The clinic disputes those allegations.
The settlement also requires the hospital to fund what is described as detransition-related care, including hormone management, endocrine services, surgical revision consultations, fertility-related services, psychological support, and care coordination for individuals who previously received interventions as minors, according to USA Today.
In addition, the agreement requires the Cleveland Clinic to establish public-facing resources promoting access to these services, including a dedicated webpage, hotline, and care coordinator within 30 days.
Federal officials said the case is part of broader enforcement efforts examining medical billing practices and gender-related treatments involving minors and referenced similar actions in other jurisdictions.
The settlement comes amid broader Washington debate over increased oversight of medical practices involving minors, a topic highlighted in remarks from President Donald Trump and his administration.
Officials also cited similar enforcement actions in Texas, where penalties, physician terminations, and a specialized care program were implemented in a comparable case.
The agreement drew sharp criticism from “trans” advocacy groups, who argued it reflects political pressure on healthcare systems and could influence how gender-related medical care is provided nationwide.
TransOhio Executive Director Dara Adkison said the settlement reflects what she described as a politically motivated effort targeting gender-affirming care, while hospital officials did not directly engage in extended comment on those criticisms.
The Buckeye Flame also reported criticism from advocates who said detransition services were being elevated in a way they view as politically driven rather than based on medical necessity, arguing demand for such services remains limited.
Ohio Republican lawmakers praised the settlement, saying it reinforces concerns about billing accuracy and compliance in medical treatment involving minors.
State Rep. Gary Click, a Republican sponsor of Ohio’s SAFE Act, said the agreement highlights ongoing concerns about “miscoding” in healthcare billing and urged other hospitals to take notice of federal enforcement actions.
The Cleveland Clinic said it remains committed to complying with all applicable state and federal laws while continuing to provide care within those legal boundaries under the terms of the settlement.
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