The Justice Department announced the resolution on June 5 and updated the release on June 9. The department said Cleveland Clinic entered agreements with the United States and the Ohio Attorney General over alleged billing connected to gender-related medical interventions for minors. The settlement agreement says Cleveland Clinic expressly denies the allegations and that the agreement is not an admission or determination of liability.
The settlement uses the term "Sex-Rejecting Procedures" for interventions for people under 18 that suppress or alter puberty or sex characteristics for the purpose of aligning with gender identity, while excluding psychological or psychiatric treatment such as talk therapy. Gender-affirming care means care for gender dysphoria, the distress that can occur when a person's gender identity differs from the sex assigned at birth. Detransition care means care for a person stopping, reversing or managing the effects of earlier transition-related treatment.
Table: Main Cleveland Clinic settlement obligations and limits
| Settlement item | Source-backed detail |
|---|---|
| Payment | $300,000 to the United States and $8,000 to Ohio, for a combined $308,000 obligation |
| Detransition-related care | $2 million total value, including insured and uninsured patients |
| Access term | Detransition care must be available regardless of ability to pay under Cleveland Clinic financial-assistance policies |
| Public access steps | Dedicated webpage, phone number and care coordinator within 30 days of execution |
| Minor-care limit | Agreement covers specified interventions for people under 18; it excludes talk therapy and other non-medical or non-surgical mental-health interventions |
| Liability posture | Cleveland Clinic denies the allegations; no determination of liability is made |
Source: US Department of Justice settlement agreement, June 2026.
The $2 million commitment can include medical care for hormonal balancing, endocrine care, surgical revision and reconstruction, fertility restoration, psychological support and insurance coordination, according to the agreement. The value may be counted through charges submitted to insurers or care written off under Cleveland Clinic's charity-care and financial-assistance policy.
The Justice Department said the resolution followed an investigation into alleged false billings submitted to public and private payors. The settlement agreement says the United States and Ohio alleged that some claims used diagnosis codes that did not properly reflect the purpose of the services. It also says Cleveland Clinic denied those allegations and entered the agreement to avoid the delay, uncertainty and expense of litigation.