The Justice Department has had trouble getting the medical records it wants from hospitals providing gender-transition treatment mutilation to minors.
The hospitals are making deals anyway.
On Friday, NYU Langone Hospitals and UPMC became the fifth and sixth major health systems to reach agreements with DOJ's nationwide investigation. NYU agreed to pay $8.5 million, UPMC will pay $950,000, and both agreed to stop providing puberty blockers, cross-sex hormones, and surgical procedures to minors.
From the Department of Justice:
“We appreciate that some of the nation’s largest and most prestigious hospital systems have agreed to cease harming minors under the guise of ‘gender-affirming care’ and agreed to pay for potential violations of federal law when they did so,” said Brett Shumate, Assistant Attorney General for the Civil Division. “But I want to be clear: 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.”
“My office’s foremost priority is protecting children. The resolutions announced today reflect the close collaboration across the Department of Justice and our continued commitment to ensuring that minors are safeguarded,” said Ryan Raybould, US Attorney for the Northern District of Texas. “These investigations are ongoing, and my office will continue to follow the evidence, act decisively when the well-being of minors is at stake, and fully pursue wrongdoers who have broken federal law.”
The agreements don't amount to admissions of wrongdoing. DOJ expressly says its claims remain allegations, there has been no determination of liability, and both hospital systems deny the allegations.
That qualifier is important because the government's investigation reaches beyond a political fight over gender medicine child mutilation. DOJ says it's examining possible violations of the Food, Drug, and Cosmetic Act, the False Claims Act, and other federal healthcare laws, including allegations that false diagnosis codes were used to obtain payment from government programs and private insurers.
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Yet DOJ hasn't been winning every legal battle along the way.
NYU received a federal grand jury subpoena seeking information about minors who received gender-related care between 2020 and 2026. In July, a federal court barred NYU from turning over identifying or sensitive health information from those patients and barred DOJ from obtaining or using it. NYU says it hasn't produced those patient records.
UPMC had a similar fight.
A federal judge in Pittsburgh rejected DOJ's effort to obtain medical records involving young patients, including a later proposal for anonymized records. The court concluded effective anonymization couldn't be assured and left the patient information protected.
So DOJ has encountered real limits on how deeply investigators can reach into children's private medical files.
At the same time, hospitals are changing course.
Mount Sinai, Texas Children's Hospital, Cleveland Clinic, Connecticut Children's Hospital, NYU, and UPMC have now reached agreements connected with the federal investigation. The terms differ, but DOJ says all six have agreed to end the covered procedure for minors.
The legal pressure clearly extends beyond possession of individual patient charts.
Hospitals have to consider federal billing rules, prescription laws, False Claims Act exposure, years of litigation, potential criminal investigations, and the enormous cost of fighting Washington. A hospital can win an argument over confidential medical records and still decide the larger legal war carries too much risk.
NYU and UPMC also received credit from DOJ for cooperating with investigators, including continuing cooperation involving other entities under federal scrutiny.
Supporters of child mutilation medicine will argue these agreements reflect federal intimidation rather than proof that the treatment was unlawful. DOJ argues it's enforcing existing healthcare and fraud laws while protecting minors.
The courts will keep deciding how far investigators may reach, while the hospitals are making another calculation in real time. Six major systems have now decided the safer legal path is to make a deal and stop the treatments.
Whatever one thinks of the underlying medicine, that is no longer just a political debate; it's becoming an institutional retreat.
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