The U.S. Department of Health and Human Services announced that its Office for Civil Rights determined Duke University School of Medicine intentionally discriminated against white and Asian applicants by using race and race‑revealing proxies in its admission process.
HHS's year‑long investigation compared grades and standardized test scores of admitted students across racial groups. It found that for the 2024‑2025 cycle Black applicants were admitted at a rate of ten percent and Hispanic applicants at six point seven percent, while only three point three percent of white and three point four percent of Asian candidates were accepted. Those higher admission rates persisted despite Black and Hispanic students having lower average grades and test scores than their white and Asian peers.
The agency's notice of violation cites internal documents that reference subjective criteria such as "overcoming hardship" and "social justice advocacy." According to HHS, admissions committee members used those criteria to identify applicants by race and to reward or penalize them in a consistent fashion, even after the Supreme Court's 2023 ruling in Students for Fair Admissions v. Harvard that bars race‑based preferences in higher education.
"OCR found that Duke School of Medicine intentionally discriminates against applicants by granting and denying admission based on an applicant's race, breaking federal anti‑discrimination laws," said Paula M. Stannard, director of the HHS Office for Civil Rights, in a release accompanying the findings.
The ruling could jeopardize Duke's tax‑exempt status. Treasury Secretary Scott Bessent and IRS chief executive officer Frank Bisignano issued regulations earlier this month that allow the Internal Revenue Service to revoke exemption for institutions that violate civil‑rights statutes. Loss of exemption would affect the university's ability to receive charitable contributions and could trigger a cascade of financial challenges.
Beyond tax status, the department warned that Duke could lose federal research funding and payments for medical services rendered by Duke Health hospitals and clinics. Those payments total billions of dollars annually, and many research grants require compliance with civil‑rights provisions as a condition of award.
The findings follow a separate Justice Department probe of Duke Law School, which in 2025 concluded that Black applicants enjoyed roughly three and a half times higher admission odds than equally qualified Asian candidates. A related investigation by the Department of Education examined alleged bias in the Duke Law Journal's selection process.
Legal experts note that the Duke cases may set a precedent for other elite institutions. The Justice Department is also suing Harvard University for refusing to provide applicant‑level data comparable to that used in the Duke investigations. A hearing on that case is slated for September 24 before Judge Myong Joun in Massachusetts.
In response to the HHS notice, Duke's School of Medicine asserted that race and ethnicity have played no role in its admissions since the Supreme Court decision. The university did not provide the requested data on test scores and grade point averages, and it has not commented publicly on the specific allegations.
University officials point to the school's withdrawal from the U.S. News & World Report rankings in January 2023 as evidence of a commitment to "excellence" and "respect for and inclusion of people from all backgrounds." Dean Mary Klotman emphasized those values when announcing the withdrawal, though the HHS report suggests a disconnect between stated policy and practice.
For American and Canadian students, the controversy raises questions about the fairness of medical school admissions that affect cross‑border training programs. Many Canadian applicants rely on U.S. medical schools for residency placements, and any reduction in federal funding could limit the capacity of institutions like Duke to host international trainees.
The tax‑exempt status of universities is governed by Section 501(c)(3) of the Internal Revenue Code, which requires that organizations operate for charitable, educational, or scientific purposes without discrimination. The Treasury's new regulations clarify that violations of civil‑rights law constitute a breach of those requirements, giving the IRS clearer authority to act.
Historically, affirmative‑action policies have been defended as tools to promote diversity in professional fields, including medicine. Critics argue that such policies can undermine merit‑based selection, while supporters contend that a diverse physician workforce improves health outcomes for underserved populations. The Supreme Court's 2023 decision eliminated the legal basis for explicit race preferences, shifting the debate to "race‑neutral" alternatives that many schools claim are insufficient to achieve desired diversity.
If Duke fails to respond within the ten‑day window specified in the notice, the department may refer the case to the Justice Department for further action. Potential outcomes include a civil penalty, loss of federal contracts, or a lawsuit to enforce compliance.
Stakeholders across the higher‑education landscape are watching the case closely. Lawmakers in several states have introduced bills to protect institutions that use holistic review processes, while civil‑rights groups argue that strict enforcement of the Supreme Court's ruling is necessary to ensure equal treatment for all applicants.
As the deadline approaches, Duke's next steps will likely shape how medical schools nationwide navigate the post‑affirmative‑action environment. The outcome will also influence how federal resources are allocated to institutions that are found to be in violation of civil‑rights statutes.