The University of California has agreed to pay $243.6m to settle claims that a former gynaecologist sexually abused hundreds of women, some of them cancer patients.
More than 200 women said they were victims of Dr James Heaps over his 35-year career and each will get $1.2m, lawyers said.
It is claimed that UCLA ignored decades of complaints and deliberately concealed the abuse.
The women have accused him of touching them sexually without gloves, simulating intercourse with a probe and making sexually inappropriate remarks.
Kara Cagle, one of the alleged victims, said she was assaulted by Heaps while she was being treated for a rare form of breast cancer.
"I could never have imagined that someone would have taken such despicable advantage of me during that time. It was so traumatic that I left in tears," she said.
The doctor was also criminally charged last year with 21 sexual offences involving seven women, to which he has pleaded not guilty.
"The conduct alleged to have been committed by Heaps is reprehensible and contrary to the university's values," said a UCLA statement.
"We express our gratitude to the brave individuals who came forward, and hope this settlement is one step toward providing healing and closure for the plaintiffs involved."
The lawsuit is the latest in a series of huge payouts by universities in similar cases.
The University of Michigan last month announced a $490m settlement with 1,000 people who said they were sexually assaulted by a sports doctor over a career of nearly 40 years.
The alleged abuser, Dr Robert Anderson, died in 2008.
An $852m settlement was also agreed last March by the University of Southern California after more than 700 women said they were also abused by a campus gynaecologist, Dr George Tyndall.