Tag Archives: medicare benefits

The Medicare circumcision rort

There is almost no medical reason to circumcise an infant. In countries where the genital integrity of children is respected, the procedure is almost unheard of. But in countries such as Australia, where the forced genital cutting of infant boys is culturally accepted, the practice continues.  And it continues with the financial support of the Australian Federal Government, through the Medicare Benefits Schedule.

Medicare claims that costs can only be claimed for ‘therapeutic’ (ie. medically necessary) infant circumcision. But given that approximately 12% of newborn baby boys in Australia result in a claim for infant circumcision, and that there is almost no medical reason for it, it is clear that Medicare is paying for non-therapeutic circumcisions.

I suspect that many doctors are falsely claiming a condition called phimosis, which is commonly known as having a tight foreskin. Read more about this phony phimosis diagnosis here.

The following chart shows claims for item 30653 (circumcision for a male under 6 months) for the calendar year 2010:

State Qty Percentage
NSW 8,707 17.72
VIC 2,952 8.17
QLD 4,791 14.52
SA 1,585 15.25
WA 1,111 6.92
TAS 49 1.48
ACT 166 6.24
NT 56 2.76

Source: Medicare MBS Item Statistics Reports

If all claims for infant circumcision in Australia were for therapeutic reasons, we would expect to see a similar rate across the states. Otherwise we would have to believe that:

  • there is major health crisis in all states other than Tasmania that causes a massively disproportionate number of baby boys to be born with such a serious genital condition that partial amputation is the only remedy; or
  • boys in Tasmania are suffering unseen/unknown ailments from their intact genitals, that are not being diagnosed by Tasmanian doctors.

The only reasonable conclusion from this data is that practitioners in all states and territories, with the possible exception of Tasmania, are inappropriately claiming item 30653 for non-therapeutic circumcisions. There can be no other explanation as to why 1.5% of Tasmanian baby boys need a circumcision, while 18% of NSW baby boys ‘need’ a circumcision.

Given the relatively small number of practitioners still offering the procedure, I suggest that it is likely that at least some of these practitioners on their own could be circumcising more that 1.48% of boys born within a State or Territory, and therefore, clearly rorting the system. The following table shows the number of procedures a practitioner would needed to have undertaken in 2010 to have circumcised 1.48% of male births:

State No. male births 1.48% of male births
NSW

49131

727

VIC

36139

535

QLD

32998

488

SA

10395

154

WA

16063

238

TAS

3317

49

ACT

2661

39

NT

2026

30

Other evidence that individual practitioners are making fraudulent claims can be found by looking at the consent forms that the practitioners ask the parents to sign. For example, the consent form from Dr Milton Sales from the Brunker Road Medical Centre in Newcastle states:

“I have been shown and understand the above risks and accept that this procedure is being performed at my request as the legal guardian of my child rather than for medical reasons.  I also understand that Newcastle Private Hospital requests payment of their admission fees either through a private health fund or if not insured, by paying $680 on the day of the operation.  I understand that the operation fee of $180 will be payable on the day at Newcastle Private Hospital by cash, credit card (please note that EFTPOS facilities are not available) or bank cheque (separate cheque to NPH fee).  This fee is partly claimable from medicare and private insurance funds.”

Note the sections in bold and underlined, which state that the circumcision is not for Medical reasons, but can be claimed from Medicare. This suggests that every circumcision performed after signing this consent form, then claimed from Medicare, is a fraudulent claim.

I suggest that it is time that Medicare, through the Professional Services Review, takes action against the doctors making these fraudulent claims.

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