The Cleveland Clinic pledged a 20-year commitment to not offer gender-changing care for minors and $2 million toward people who detransition in a settlement with the Department of Justice.
The agreement, announced by the DOJ and Ohio Attorney General Dave Yost's office on Friday, marks the second major settlement secured by the Trump administration as it intensifies scrutiny of pediatric gender-transition procedures and related billing practices.
Under the settlement, Cleveland Clinic agreed not to provide, facilitate, coordinate, or refer minors for puberty blockers, cross-sex hormones or other procedures described by federal officials as "sex-rejecting procedures" for the next two decades.
The restrictions remain in place regardless of future legal challenges to Ohio's existing ban on such treatments for minors.
The healthcare giant also agreed to commit $2 million to provide care for detransitioners — individuals seeking to reverse or address the effects of medical gender-changing treatments received as minors.
The funding will support services including hormone balancing, surgical revision and reconstruction, fertility restoration, psychological counseling and insurance coordination regardless of a patient's ability to pay.
In announcing the agreement, the DOJ described detransitioners as victims of "harmful consequences" resulting from medical interventions performed on children and adolescents.
"The Department of Justice is steadfastly committed to protecting America's children," Associate Attorney General Stanley Woodward said. "Today's resolution with Cleveland Clinic furthers that commitment and puts these providers on notice that this Department will vigorously enforce federal law where children are put at risk."
The settlement also resolves allegations that Cleveland Clinic improperly billed Ohio Medicaid and other insurers for services related to minors receiving treatment for gender dysphoria.
Federal and state officials alleged the hospital system used diagnosis codes for unspecified endocrine disorders instead of codes that more accurately reflected the treatments being provided.
Cleveland Clinic agreed to pay $308,000 to resolve the claims but denied wrongdoing.
The health system characterized the matter as an "unintentional coding issue involving a small number of patients."
"We remain focused on providing exceptional care to our patients and communities," Cleveland Clinic said in a statement.
The agreement follows a similar settlement reached last month with Texas Children's Hospital, which agreed to pay a $10 million penalty, permanently cease gender-changing procedures for minors and establish what federal officials described as the nation's first clinic dedicated to treating detransitioners.
Assistant Attorney General Brett Shumate said the administration's broader investigation remains ongoing and could extend to additional healthcare providers and pharmaceutical companies.
"Our work is far from over," Shumate said. "We will continue to work tirelessly to protect America's children and hold accountable those that have preyed on vulnerable children."