Medicare data indicates doctors are performing circumcisions on females, many under the age of five. Health authorities are claiming a computer error but an investigation by Tasha May has found alarm among community groups.
Data publicly available on Services Australia’s website records that between July 2013 to July 2021 there were 1,836 claims made under the Medicare code for the circumcision of the penis but recorded for female patients. Over half of these claims were for girls under 15 years of age.
All states and territories have enacted criminal legislation prohibiting female circumcision, known more commonly as female genital mutilation (FGM). However, Khadija Gbla, a survivor of FGM and Director of Ending FGM Australia, says it’s a fact that FGM does still occur in Australia and that a conservative estimate suggests that 11 girls a day are at risk.
Gbla said she would not be surprised if some are subsidising the practice under Medicare as “we know Medicare fraud occurs” and the high numbers of occurrence appear “too much for it to be a coincidence.”
Betul Tuna, Project Officer for the Ethnic Council of Shepparton, said that their investigation found several male circumcision clinics entertained the idea of performing the circumcision on females while other clinics directed them to home circumcision avenues.
Source: Medicare investigation indicates female genital mutilation in Australia – Michael West Media
Medicare funding of female circumcision
Female genital mutilation is against the law but Medicare has been paying doctors for female circumcision since July 2013.
On 1 July 2013, new guidelines from the Australian Government on sex and gender stated that the chromosomal, gonadal and anatomical characteristics associated with biological sex are distinct from gender. ()
As soon as gender was defined as social rather than biological, female “circumcision” appeared in Medicare statistics. ()
* 2,048 girls and women were “circumcised” from 1 July 2013 to 30 Sept. 2022.
* 835 (40.77%) were girls less than 5!
* Another 159 (7.76%) were girls between the ages of 5 and 15.
970 (47.36%) of the females ‘circumcised” under Medicare were under 15! ()
There are laws against female genital mutilation but Medicare has been paying for “female circumcision” since July 2013.
This can’t be explained away as “coding errors.”
Look at Medicare statistics on vasectomies and circumcisions from 2013-2022.
Female vasectomy rates and female circumcision rates, 2013-2022
Procedure
Circumcision and Vasectomy numbers of both genders, 2013-August 2022
2013- August 2022 females only
Number of procedures on girls under 15
Number of procedures on girls under 5
Circumcision
201,667
1,985 ()
970
815
Vasectomy () ()
246,193
301 ()
0
0
There were:
• More vasectomies than circumcisions, but
• 6.6 times as many ‘female circumcisions’ as ‘female vasectomies’!
• 994 circumcisions of girls under 15 but NO vasectomies of girls under 15!
• 815 circumcisions of girls under 5!
Female vasectomy rates are certainly anomalous, but female circumcision rates are 6.66 times higher!
Was it “incorrect data entry?”
Was it incorrect data entry, like billing person 4 instead of person 3 on a family Medicare card?
If so, why has Medicare recorded 994 girls under 15 being “circumcised” from July 2013 to September 2022?
Medicare records hundreds of circumcisions of girls under 15 but no female vasectomy on girls under 15!
Female genital mutilation is against the law. Why didn’t this payment raise red flags?
Labiaplasty
Labiaplasty procedures (item numbers 35533 and 35534) rose from
1,625 in 1993-1998 () to
7,305 in 2008-2013 () They then declined to
4,487 in 2013-2018 () and
1,927 in 2018-2022 [4 years] ()
The rules for item number 35334 were tightened in November, 2018. () However, labiaplasty of girls continued to be subsidised under item number 35533, including 3 labiaplasties on girls under the age of 5 and 11 labiaplasties on girls 5-15, after November 2020. ()
The remedy:
Make sure item number 35533 (labiaplasty) subject to detailed clinical notes like item number 35534. If detailed clinical notes were required to justify this payment for both item numbers, it would close a loophole for questionable claims. Item number 35533 would still provide for the surgical repair of female genital mutilation or a major congenital anomaly of the uro-gynaecological tract in younger patients, but demanding detailed clinical notes to receive the payment would help to safeguard both patients and Medicare from abuse.
Medicare is for medical needs, not other reasons.
In the financial year, 2021/2022, Medicare paid $2,698,831 for 21,290 circumcisions. Over 1% of this was for the “circumcision of the penis” of 229 females, 72 of whom were under the age of 5! ()
The law prohibits the genital mutilation of females so any payment for female circumcision and female child circumcision should raise red flags.
Even if Medicare is blind to the difference between male and female, it can still discourage female circumcision. To get this subsidy, doctors should have to document the fact that their patient has a penis, with a medical need for circumcision!
Restricting the Medicare subsidy to those whose penis has a medical need for circumcision won’t ban circumcision.
However, the Medicare subsidy must be subject to two requirements:
1 The patient must have a penis and
2 The medical need for the circumcision must be documented.
This is not too much to ask.
I read the story by Natasha May on the misuse of Medicare number 30654 circumcision for FGM. I wanted to highlight the misuse of MBS item number 35533 labiaplasty. Between Jan 2001 and Dec 2013 there was 102 claims for item 35533 for baby girls 0-4 years of age,and 247 for 5-14 year olds. 68 of the 102 baby girls given a labiaplasty or FGM were in South Australia. I suspect if you were to match the provider number to these claims, you would find it was the same doctor. Given the fact that FGM is illegal in all Austarlian states and territories and there is mandatory reporting of this crime, there is a doctor in Adelaide who should have been prosecuted. Greg Hunt had a legal obligation to follow up on the concerns raised when he was contacted last year. Medicare should be checking the gender of the circumcision claims and also the age of the genital surgery claims.