After a year-long legal battle, the U.S. Department of Justice and the State of Ohio have reached a settlement with the Cleveland Clinic. In the lawsuit, the federal government found that Cleveland Clinic knowingly used inaccurate diagnosis codes to falsify public insurance coverage. While originally the codes were disguised as routine coverage for youth, they were instead used to provide gender-affirming care for minors which is against Ohio House Bill 68.
Despite the bill banning puberty blockers and similar medication, it does not block such drugs from being used for other endocrine disorders that require urgent treatment. This is the same loophole that was attempted by Cleveland Clinic. Proponents of the bill say that such treatments offered to children before adulthood could lead to permanent effects on physical, mental and emotional health.
Ohio’s Saving Adolescents from Experimentation (SAFE) Act aims to protect adolescents from experimentation while they are still developing. Processes under the Act include gender change surgeries and psychological gender-reaffirming treatments. The Act was passed in 2023 after a strenuous process involving a veto from Gov. Mike DeWine (R). However, the Ohio Legislature subsequently overrode the veto in January 2024, and the bill took effect in April later that year.
The Cleveland Clinic cover-up was allegedly going on from 2020 all the way to the summer of 2026. Cleveland Clinic reportedly used generic and non-specific terms such as “unspecified endocrine disorders” to be intentionally vague, allowing providers to prescribe puberty blockers and cross-sex hormone therapies for minors.
Initially, the Cleveland Clinic denied all allegations, saying that the codes and vagueness were part of an unintentional system mistake rather than an obfuscation of evidence. However, the case eventually reached the Department of Justice, where a settlement was reached by the U.S. Attorney’s Office of the Northern District of Ohio after a year.
The terms stated that $308,000 will be paid to federal and state-level governments as a settlement sum, resolving the allegations for falsifying insurance billing records. Additionally, Cleveland Clinic must ban such treatments on minors for a minimum of two decades (brought down from the initial verdict of a permanent ban on such treatments). The agreement also pledges 2 million dollars to patients who desire restorative care services for changes made by gender-reaffirming treatments.
“The Department of Justice is steadfastly committed to protecting America’s children,” stated Associate Attorney General Stanley Woodward, when asked about his reaction to the settlement agreement.
However, not all Ohio residents are happy about the change. Most notably, the LGBTQIA+ Community Center of Greater Cleveland has expressed their deep disappointment in the decision, stating that they will continue to support youth as they explore their identities.
The DOJ has made several moves in this policy area, and the Cleveland Clinic lawsuit is not the first. Earlier in the year, the DOJ took on Texas Children’s Hospital for similar claims involving gender-reaffirming care for minors. Similarly, the hospital agreed to pay a fine of 10 million dollars to settle, and they also dedicated a clinic for retransitioning minors. These clinics break new ground and may serve as a unique precedent for pediatric care in the future.
“I am grateful that institutions like Cleveland Clinic and Texas Children’s have decided to be part of the solution, not part of the problem,” said Brett Shumate, Assistant Attorney General for the Civil Division. She went on to say that their work is not over, and that these two hospitals are but the first in a long line of healthcare institutions that will be investigated over time.