medicare funding fraud
The Australian Government Health Department (AGHD) specifies funding for circumcision is not payable in the absence of a legitimate medical condition that would warrant the procedure.
This includes exclusion from Medicare funding in instances where the decision to circumcise is based on cosmetics, prophylaxis, tradition, culture, or religion.
Medicare funding as an unlawful inducement is substantial, often covering half the associated cost and in cases where safety net thresholds have been exceeded (private births), most cost.
Common elements associated with circumcision services, all separately billable under Medicare:
- Initial consultation.
- Consultation on the day of or just prior to the procedure.
- Post-operative consultation(s).
- Procedure rebate.
Providers are inappropriately claiming multiple rebates for non-medical circumcision through their consultation fees.
The misappropriation of this funding comes at the cost of legitimate healthcare intervention.
CLR conduct annual surveying to determine the wiliness of practitioners to unlawfully access Medicare funding. This information is then submitted to Provider Benefits Integrity (PBI) who are responsible for compliance in association with Medicare funding.
Our efforts have implicated 23 doctors conspiring to commit 32 separate counts of Medicare fraud.
Regardless of measures imposed by authorities this funding abuse remains systemic warranting withdrawal of all Medicare based funding. In instances where legitimate intervention can be justified this service is available free of charge in the public sector.
Most parents will not be aware of or agree to these fraudulent claims of Medicare funding, this is solely the responsibility of the practitioner.
If you feel you were misled or deceived concerning the appropriateness of Medicare funding, we encourage you to submit your concerns to Provider Benefits Integrity.
The following examples demonstrate the result of CLR intervention
Implicated for Medicare fraud, website deleted
Implicated for Medicare fraud, website placed permanently in maintenance mode
All circumcision services withdrawn
All circumcision services withdrawn
Implicated for Medicare fraud, all references to pricing and Medicare funding removed in an attempt to conceal guilt.
All circumcision services withdrawn
All circumcision services withdrawn
Implicated for Medicare fraud, all references to pricing and Medicare funding removed in an attempt to conceal guilt.
Decline in Medicare Claims 2020-2023
A clear trend of decline is evident concerning both Medicare item numbers.
Item 30658 overall 11.64% decline, 0-4 yrs 21.22% decline, 5-14 yrs 10.67% decline.
The state of Victoria has recorded a decline of 47.47% in the age range of 0-4 yrs.
Item 30654 overall 24.75% decline, 0-4 yrs 23.4% decline, 5-14 yrs 40.66% decline
Significant decreases are noted in all states.
This prominent decline for the reporting period is likely the product of –
ā The practice remaining unpopular with parents in general.
ā Campaigning by organisations such as Circumcision Law Reform to combat Medicare
and advertising fraud.
ā Additional compliance measures applied by Medicare.
It is improbable that this significant progressive decline has occurred due to a decrease in the need for legitimate medical intervention and is more indicative of a reduction of fraudulent Medicare billing.
Circumcision Law Reform 