The federal government has emphasised that the circumcision of boys must be proved medically necessary to claim Medicare benefits, but has declined to answer questions about the extent of the practice in Australia.

In a letter to the Rationalist Society of Australia (see below), Nigel Murray, an Assistant Secretary in the Medical Benefits Division, said providers of circumcision services had to comply with the rules when claiming Medicare benefits.

“This includes, for example, appropriately documenting a circumcision was medically necessary,” he wrote.

In December, RSA president Meredith Doig wrote to federal health minister Mark Butler and assistant minister Ged Kearney, urging the government to put a stop to the non-clinical circumcision of non-consenting boys in Australia – performed, for example, for social, cultural or religious reasons. 

She asked them to confirm whether taxpayers were paying for non-clinical circumcision through the Medicare system and, if so, how many circumcisions were being performed and how much the practice was costing taxpayers.

She pointed to data – revealed by author and human rights advocate Jonathan Meddings at a recent RSA Webinar – that annual Medicare claims related to penile circumcision have remained constant at more than 20,000 in recent years and peaked at almost 23,000 in 2020/21 during the pandemic.

Mr Meddings said private clinics whose business model was to have “boys on a conveyor belt” were fraudulently making Medicare claims because most circumcision procedures would not be considered as ‘clinically relevant’.

In his reply, Mr Murray did not respond to the RSA’s questions, but said the government relied on practitioners to uphold the principle of clinical relevance.

“The Government relies on the judgement of health practitioners in determining the appropriate care for patients and upholding the principle of clinical relevance when deciding whether a procedure, such as circumcision services provided under MBS items 30654 and 30658, is necessary,” he said.

“In the event of a compliance audit or review, a provider must have records or information that demonstrates compliance with the rules when claiming Medicare benefits.”

The RSA has also raised the matter with several federal MPs and Senators but has not received a reply.

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Photo by Picsea on Unsplash.

Letter from Assistant Secretary Nigel Murray, 17 January 2023

Dear Dr Doig,

Thank you for your correspondence of 14 December 2022 to the Minister for Health and Aged Care, the Hon Mark Butler MP and Assistant Minister for Health and Aged Care, the Hon Ged Kearney MP regarding circumcisions in Australia. The Minister has asked me to reply.

The Medicare Benefits Schedule (MBS) provides benefits (or patient rebates) for a range of professional medical services, including circumcision of the penis. For all procedures across the MBS, the Health Insurance Act 1973 requires all claims through the MBS to be clinically relevant, and generally accepted in the medical profession as being medically necessary and appropriate treatment for the patient.

The Government relies on the judgement of health practitioners in determining the appropriate care for patients and upholding the principle of clinical relevance when deciding whether a procedure, such as circumcision services provided under MBS items 30654 and 30658, is necessary.

In response to your question on the number of clinically relevant circumcision services funded under the MBS, you are able to access item reports for all MBS services by visiting the Medicare statistics website at: www.servicesaustralia.gov.au by searching Medicare statistics. Data can be accessed on the number of services, MBS benefits paid and patient age for MBS items 30654 and 30658 for each financial year.

In the event of a compliance audit or review, a provider must have records or information that demonstrates compliance with the rules when claiming Medicare benefits. This includes for example, appropriately documenting a circumcision was medically necessary.

Any evidence or specific allegations about misuse of Medicare should also be referred via the Provider Benefits Integrity Hotline by calling 1800 314 808 between the hours of 9am and 5pm AEST, or by email to provider.benefits.integrity@health.gov.au, or through the Department’s tip-off form which is available at www.health.gov.au by searching fraud-tip-offs.

Thank you for writing on this matter.

Yours sincerely

Nigel Murray

Assistant Secretary

MBS Policy and Specialist Services Branch

Medical Benefits Division