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Texas Children’s Hospital (TCH) in Houston, which holds the distinction as the largest children’s hospital in the United States, has agreed to establish a multidisciplinary detransition clinic as part of a settlement resolving a multi-year investigation into its billing practices for gender-transition procedures for minors.

Under the terms of the settlement, which was obtained in conjunction with the Texas Attorney General’s Office, TCH will pay $10 million in damages and civil penalties to resolve allegations that it submitted false billings to Texas Medicaid and other payers for unallowable gender-transition procedures on children, including the use of false diagnosis codes.

In addition, the hospital has committed to ceasing the administration of puberty blockers and cross-sex hormones to minors, terminating and permanently revoking the medical privileges of five physicians who provided such interventions, and implementing additional compliance and ethics measures. It will also amend its bylaws to require automatic relinquishment of privileges for any physician violating Texas law prohibiting medical interventions to transition minors.

The settlement requires TCH to establish what officials have described as the nation’s first multidisciplinary detransition clinic. The clinic is intended to provide medical and restorative care to patients who underwent gender-transition procedures.

All services at the clinic will be funded by the hospital and offered free of charge to patients for the first five years of operation. The Department of Justice noted that TCH has agreed to dedicate millions to the provision of such care for children harmed by the procedures, referred to as detransitioners.

“Under the terms of this landmark agreement, Texas Children’s will establish the first-ever multidisciplinary clinic designed to provide medical care to patients who were subjected to ‘gender-transition’ procedures. This Detransition Clinic will help patients reverse the damage caused by ideologically-motivated physicians who harmed patients by performing dangerous medical interventions for the purpose of ‘transitioning’ them,” Texas Attorney General Ken Paxton said following the settlement’s announcement.

“For the first five years, all services provided through the Detransition Clinic will be funded by Texas Children’s and be free of charge to patients,” he added.

The investigation originated in 2023 through the Texas Healthcare Program Enforcement Division, following the state’s passage of legislation barring gender-affirming care for minors. TCH cooperated with the probe and produced more than 5 million documents, according to hospital statements.

In its response to the settlement, Texas Children’s Hospital said it made “the difficult decision to settle with the Texas Attorney General and the Department of Justice, closing a chapter that has been wrought with falsehoods and distractions.” The hospital continued: “To be clear – we are settling to protect our resources from endless and costly litigation. This settlement will allow us to redirect those precious resources to focus on the life-saving care and groundbreaking discoveries of our exceptional clinicians and scientists.”

The Department of Justice acknowledged TCH’s cooperation during the investigation and noted that the claims resolved are allegations only, with no determination of liability.

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