NYU Langone and UPMC Settle With the DOJ. That Makes Six Hospitals That Have Signed Away Trans Youth Care.
NYU Langone will pay $8.5 million and UPMC $950,000 under Justice Department deals that keep gender-affirming care closed to minors. What started as subpoenas has become a template, and it now runs through the settlement table more than the courtroom.
On Friday, September 18, the U.S. Department of Justice announced settlements with two of the country’s largest health systems, New York University Langone Hospitals and the University of Pittsburgh Medical Center (UPMC). Both close federal investigations into the hospitals’ pediatric gender-affirming care programs. Under the terms the department announced, both will stop providing puberty blockers, hormone therapy and surgery to patients under 18, and both will pay the government: $8.5 million from NYU Langone and $950,000 from UPMC.
We have covered this fight before, first when New York families sued to stop the DOJ from seizing trans youth’s records at NYU Langone and later when an appeals court sided with the DOJ in its subpoena fight with QueerDoc. This week shows what the subpoenas were for. The legal fight over records has turned into a string of negotiated exits, and each one makes the next easier.
What the hospitals agreed to
The Justice Department’s announcement says the agreements “resolve investigations into potential violations of federal law.” The department has framed its probes around alleged “fraudulent billing practices” used to get paid by federal health programs and private insurers, according to reporting by The Advocate. Neither hospital admitted wrongdoing.
NYU Langone said it settled to end the investigation and avoid handing over confidential information about patients treated for gender dysphoria as minors. The hospital had received a subpoena for that information in May. “NYU Langone has not entered into this settlement because of any wrongdoing and has affirmatively denied any wrongdoing or liability in the agreement,” spokesperson Steve Ritea told Gothamist.
According to Pittsburgh’s WESA, UPMC’s deal is a ten-year moratorium on the care for patients under 19. A UPMC spokesperson said the agreement includes “privacy, confidentiality, and non-prosecution protections for patients, legal guardians, providers, and employees.” WESA noted that the formal terms had not been published. It also reported that the DOJ had dropped its pursuit of UPMC patient records about a month earlier.
In practice, little changes for families on the ground this week, because both systems had already stopped this care. UPMC ended gender-affirming care for patients under 19 last summer, and NYU Langone shut its program earlier this year after the administration threatened hospitals’ federal funding. What the settlements add is permanence, a price tag, and a written promise to the federal government that the programs will stay closed.
The pattern
Taken one at a time, each deal looks like an institution protecting itself. Taken together, they describe a strategy. The DOJ has subpoenaed dozens of hospitals since July 2025, according to LGBTQ Nation. Since May, similar agreements have been reached with the Cleveland Clinic, Connecticut Children’s, Texas Children’s Hospital and Mount Sinai Health System in New York. Mount Sinai settled earlier this month, and Gothamist reported that NYU Langone’s payment is similar to the “monetary penalty” Mount Sinai paid. That brings the count to at least six.
The department has said plainly that it is not finished. “I want to be clear: our efforts and investigations into other providers are ongoing,” Brett Shumate, assistant attorney general for the DOJ’s Civil Division, said in a statement quoted by Gothamist. “Those that have broken the law and not resolved their potential liability will be prosecuted to the fullest extent possible.” Attorney General Todd Blanche described the effort as “working tirelessly to reach agreements with hospitals” to end the care.
The DOJ also credited UPMC with “ongoing cooperation in the department’s investigation of other entities.” It did not say what it will do with the money. In earlier settlements, The Advocate noted, the department said part of the funds would go toward so-called detransition services.
This is happening alongside court fights where the government has sometimes lost. Judges have blocked records demands at several hospitals, including Stanford, and the DOJ walked away from its appeal over UPMC’s records. Even so, the settlements are getting the administration the result it wants: programs closed for years, without a court ever ruling that the care was unlawful.
The reaction
New York officials criticized NYU Langone directly. Mayor Zohran Mamdani called the deal “yet another alarming example of a private institution caving to pressure from the federal government,” and said it “politicizes families’ most private medical decisions.” Rep. Jerrold Nadler said he was “disappointed in NYU Langone for acquiescing.” The New York attorney general’s office said it was reviewing the settlement.
Lambda Legal, the NYCLU and the ACLU represent families in Coe v. Blanche, the federal class action challenging the DOJ’s attempts to seize trans youth’s records. In a joint statement they called the NYU Langone and Mount Sinai settlements “beyond shameful.”
Kei Williams, executive director of The New Pride Agenda, summed up what many advocates see: “This is no longer one hospital making an isolated decision. We are watching a pattern take hold.” In Pittsburgh, Lyndsey Sickler of the group TransYOUniting told CBS Pittsburgh the approach is “going to cost them a lot more than $1 million.”
What it means for families
Major medical associations still consider gender-affirming care for adolescents safe and appropriate, and research has linked it to better mental health outcomes. None of that has changed. What has changed is where the care is available. In two of the country’s largest metro areas, the big academic medical centers that trained specialists and took complex cases have now signed written commitments to stay out of it.
Families in New York and Pennsylvania still have options. Gender-affirming care for minors remains legal in both states, and smaller clinics and private practices continue to provide it. But each settlement shrinks the network, and every hospital that signs makes the pressure on the next one heavier. The DOJ has said it has more investigations underway. The important question now is whether the remaining hospitals under subpoena decide to fight in court or to settle.
Sources: U.S. Department of Justice, via HHS-OIG; LGBTQ Nation; The Advocate; Gothamist; WESA. Photo: Ajay Suresh, CC BY 2.0, via Wikimedia Commons.
