The chickens have a way of coming home to roost in American healthcare, especially when accountability is ignored. The Justice Department’s recent resolution with the Cleveland Clinic, which required the system to pay to settle allegations tied to improper billing for pediatric transgender procedures, is not a small matter. It is a warning to every institution that believes complexity can hide misconduct. Even one of the nation’s most celebrated hospital systems is not beyond scrutiny when incentives are misaligned and transparency is absent.

The Justice Department says the Cleveland Clinic agreed to settle claims that it billed federal programs for services that did not meet applicable requirements, including those tied to the transgender sterilization of minors. Beyond settling the billing allegations, Cleveland Clinic agreed to a decades-long ban on performing or offering sex-rejecting procedures — including puberty blockers and cross-sex hormones — for minors, and committed $2 million to provide restorative care for detransitioners.

The conduct alleged here should trouble anyone who believes public money must be spent honestly and fairly.

Last year, I warned that the Cleveland Clinic owed patients........

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