NYU Langone and UPMC Settle With the Justice Department Over Youth Gender Care

The Justice Department announced agreements on September 18, 2026 with NYU Langone Hospitals and the University of Pittsburgh Medical Center resolving investigations into their pediatric gender-affirming care programs. NYU will pay $8.5 million and UPMC $950,000. Both systems expressly denied every allegation.

These are the latest in a run of federal hospital settlements, and they are worth reading slowly, because what the government says the agreements accomplish and what the hospitals say they accomplish are not quite the same document. We keep the running record at our Transgender History & Education hub. Below is what each side put in writing.

What did the Justice Department announce?

Agreements under which both systems stop providing puberty blockers, cross-sex hormones and surgical procedures to minors, and each pays a sum to resolve the investigation.

According to the Justice Department’s announcement of the NYU and UPMC agreements, the department said the two systems “will cease providing these dangerous interventions to minors.” Attorney General Todd Blanche said the resolutions “send a clear message: hospitals that target children in these practices and then fraudulently obtain payment for the procedures will be held to account.” The phrases “dangerous interventions” and “sex-rejecting procedures” are the department’s own characterizations, used throughout its release, and they are not findings by any court.

What are the hospitals paying, and what did they admit?

NYU pays $8.5 million and UPMC $950,000 — $9.45 million between them — and neither admitted anything.

The department’s release states plainly, in its own closing line, that “the claims resolved by the United States in these agreements are allegations only, and there has been no determination of liability,” and that both systems “have expressly denied all allegations.” NYU Langone’s public notice puts it the same way: the system has not settled because of any wrongdoing and has affirmatively denied wrongdoing or liability. Its notice adds that the resolution does not affect its pediatric mental health programs or care for patients eighteen and over. The department also credited both systems for cooperating with its investigation, including with inquiries into other providers.

What law was the department investigating?

Not the medicine itself, but billing and drug law — principally the False Claims Act and the Food, Drug, and Cosmetic Act.

The release describes a nationwide investigation launched after a 2025 presidential directive, examining “potential violations of the Food, Drug, and Cosmetic Act, the False Claims Act, and other federal health care laws, including fraudulent billing practices such as the use of false diagnosis codes.” The work was coordinated among the Civil Division, the U.S. Attorney’s Office for the Northern District of Texas, the HHS Office of Inspector General and the FDA Office of Criminal Investigations. That framing matters: a fraud theory lets the government reach a clinical practice without ever having to litigate whether the practice is sound.

Which hospitals settled before these two?

Four others, all named in the department’s own release, which is what makes this a pattern rather than an incident.

The department’s release names prior agreements with Mount Sinai Health System, Texas Children’s Hospital, the Cleveland Clinic Foundation and Connecticut Children’s. Brett Shumate, the Assistant Attorney General for the Civil Division, said that “our efforts and investigations into other providers are ongoing,” and that providers who have not resolved their potential liability “will be prosecuted to the fullest extent possible.” The list of hospitals is, on the department’s own account, not final. For the wider policy picture, our guide to transgender laws and policy sets out how these threads connect.

Worth noting is who is absent from the announcement. The release quotes the attorney general, an assistant attorney general and a U.S. attorney. It does not quote a clinician, a patient or a parent, and it gives no figure for how many young people were in these programs. That is normal for a press release, but it is the reason a reader should treat the document as one party’s account of a negotiation rather than a record of what happened.

Why does a settlement matter more than a ruling here?

Because no judge weighed the evidence, and the outcome still changed what care exists.

A settlement is a decision to stop fighting. If a hospital’s realistic choices are a long federal investigation or a payment plus a commitment, the calculation tilts toward the payment whatever the clinical evidence shows. That is leverage operating upstream of any ruling, and it has been moving alongside the records fight we covered when the Ninth Circuit revived a Justice Department subpoena for transgender patient records, and alongside coverage policy such as the federal Medicaid rule restricting coverage for minors and the department’s suit against a Kansas school district.

Supporters of the settlements see a regulator doing what regulators are for: examining billing, finding what it considered unlawful, and stopping it. Critics see a case never tested, a denial on the record, and care ending anyway. Both descriptions fit the same paperwork, and a reader is entitled to notice that the paperwork does not settle the underlying medical question at all.

What happens next?

The investigations continue, and the families affected have not been counted in public.

What no one has said is how many young people were receiving care at these systems, or where those families go now. Shumate said the inquiries are ongoing, so the number of hospitals is likely not final either. None of this is medical or legal advice; it is a record of what two institutions agreed to and what the government said about it. Our transgender FAQ explains the terms that keep recurring in these stories.

Frequently asked questions

Did a court find NYU Langone or UPMC did anything wrong?

No. The Justice Department’s own release states that the claims resolved are allegations only, that there has been no determination of liability, and that both systems expressly denied all allegations. These are negotiated agreements, not judgments, and no judge weighed the evidence on either side.

How much are the two systems paying?

NYU Langone Hospitals agreed to pay $8.5 million and the University of Pittsburgh Medical Center $950,000, which is $9.45 million between them. The payments resolve the investigations rather than representing any finding of liability.

What care are the agreements stopping?

The department says both systems will cease providing puberty blockers, cross-sex hormones and surgical procedures to minors. NYU Langone’s public notice states the resolution does not affect its pediatric mental health programs or care for patients eighteen and over.

What federal laws were being investigated?

The release names the Food, Drug, and Cosmetic Act, the False Claims Act and other federal health care laws, with an emphasis on billing practices such as the use of false diagnosis codes. The theory is a fraud and drug-law theory rather than a direct judgment about the medicine.

Which hospitals had already reached agreements?

The department lists Mount Sinai Health System, Texas Children’s Hospital, the Cleveland Clinic Foundation and Connecticut Children’s. NYU and UPMC are the fifth and sixth systems named, and the department says investigations into other providers remain open.

Is the Justice Department still investigating other hospitals?

Yes. Brett Shumate, the Assistant Attorney General for the Civil Division, said investigations into other providers are ongoing and that those who have not resolved their potential liability will be prosecuted. The department also credited NYU and UPMC for cooperating with inquiries into other entities.