The Justice Department announced agreements with NYU Langone Health and UPMC on September 18, 2026 under which both will stop providing gender-affirming care to minors. NYU will pay $8.5 million and UPMC $950,000.
The legal theory was not about the care itself. The department pursued allegations of fraudulent billing under the False Claims Act and the Food, Drug, and Cosmetic Act, and it leveraged grand jury subpoenas for patient records to get there. The settlements are civil, both systems denied wrongdoing, and the department conceded there has been no determination of liability.
That combination is the point worth recording: a policy outcome the administration wanted, reached through a billing-fraud investigation and the threat of compelled disclosure of individual patients' medical records, rather than through a rule or a statute.
The route matters because the direct one had already failed. A federal judge quashed the department's subpoena for UPMC patients' records in December 2025, calling the government's conduct “unprecedented,” and the department abandoned its appeal in August 2026 (see The DOJ Abandons Its Appeal to Seize Transgender Minors' Medical Records From a Pittsburgh Children's Hospital). Five weeks later it obtained the same outcome by settlement. The picture is not one-sided, though: in a separate case in August 2026 the Ninth Circuit held 2 to 1 that the administration's goal of ending this care for minors is not an improper purpose and cannot by itself defeat the subpoenas, which the Associated Press describes as having given the government's case a boost.
Update (September 23, 2026): NYU and UPMC are not the first two, they are the fifth and sixth. Headlines describing “two more hospitals” refer to these same two systems, not to additional ones. The sequence: Texas Children's Hospital on May 15, 2026, the Cleveland Clinic Foundation on June 5, Connecticut Children's Hospital on August 5, Mount Sinai Health System on September 4, then NYU Langone and UPMC on September 18. Six systems in four months.
The department's own announcement supplies the link to the president. “In 2025, President Trump directed the Department of Justice to prioritize investigations and enforcement actions involving violations of federal law in the provision of so-called 'gender-affirming care' to children,” it says, describing a “nationwide investigation into the child gender-transition industry.” 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.” Assistant Attorney General Brett Shumate was explicit that this is not over: “our efforts and investigations into other providers are ongoing. Those that have broken the law and not resolved their potential liability will be prosecuted to the fullest extent possible.” The investigation has been moved from Main Justice to the Northern District of Texas, under U.S. Attorney Ryan Raybould.
Four of the six settlements are with providers in states where the care is legal. Connecticut, New York and Pennsylvania have no ban, and Connecticut and New York have shield laws meant to protect it. Twenty-seven states do restrict or bar it. The department says some providers have also agreed to help pay the medical costs for children to detransition. When this entry was first written the agreements had not been released, and the age cutoff could not be stated precisely: the Associated Press reported patients under 19, other outlets under 18, and the department's own release said only minors (see the September 29 update).
The hospitals deny wrongdoing. NYU Langone said it “has not entered into this settlement because of any wrongdoing and has affirmatively denied any wrongdoing or liability in the agreement,” and that the resolution protects patients, providers and the institution “from prolonged litigation.” UPMC said it “chose to resolve the matter to avoid prolonged litigation, protect patients and families from unnecessary disclosure of sensitive personal and health information.” Mimi McKenzie of the Public Interest Law Center answered that “gender-affirming care is legal in Pennsylvania, and gender-related discrimination is not,” and Chris Geidner noted the distinction that makes these agreements different from a hospital simply stopping: “there is a significant difference between voluntary cessation and a signed settlement agreement in which ending such care is a condition of the settlement.” Most major medical organizations, including the American Medical Association and the American Academy of Pediatrics, support keeping the treatment available.
Update (September 29, 2026): UPMC has posted its two agreements, and they are more specific than the announcement. They bar the care for 10 years, Pittsburgh's Public Source reported, but end early if the Pennsylvania Supreme Court or the U.S. Supreme Court issues a final ruling that withholding it violates federal or state law: “In the event of such an order, UPMC's obligations … are terminated,” one reads. They are inconsistent on age, describing the accusations in terms of patients under 18 while one defines covered conduct as applying to anyone under 19. The billing theory is that UPMC billed insurers for “'medically necessary' drugs to treat gender dysphoria where the patients did not meet the criteria for reimbursement,” which UPMC denies. UPMC must also help the department investigate drugmakers, including producing “records of any relevant communications between its employees and pharmaceutical manufacturers.”
Six complaints on behalf of transgender patients are pending before the Pennsylvania Human Relations Commission and are not resolved by the agreements. Elizabeth Lester-Abdalla of the Women's Law Project said UPMC “can put whatever they want in their agreement,” adding, “That doesn't mean that it'll be upheld by a court of law under scrutiny.” Protesters gathered outside UPMC Children's Hospital on September 27.
Correction (September 29, 2026): this entry said the agreements had not been released. UPMC has posted its two agreements; the entry now describes their terms.