The Backlash! - July 1996

Organization News - National Organization to Halt the Abuse and Routine Mutilation of Males
P.O. Box 460795 San Francisco, CA 94146
Tel/Fax 415-826-9351

Reporting Medicaid fraud

Medicaid (in California, MediCal) is a program of medical assistance for low-income citizens. It is funded by the federal government and administered by the states. There are broad federal guidelines, but it is up to the discretion of each state Medicaid Director/Consultant as to how these scarce funds will be spent.

Every state has a policy about whether routine infant circumcision (RIC) is covered. Since RIC removes or separates normal, healthy functioning genital tissue, there is no medical indication fo rthis surgery. By authorizing Medicaid payment for non-medically indicated procedures, state Medicaid Directors/Consultants are defrauding the federal Medicaid program.

You can expose Medicaid fraud in your state, which is a felony.

Our hope is NOT to punish unwitting Directors/Consultants, but that the investigation itself will have a spinoff effect of forcing the Medicaid program to re- evaluate RIC payments and design stringent guidelines against payment of this non-medically indicated surgery.

The long-term impact will likely be a dramatic reduction in the circumcision rate by removing a government-financed payment mechnism. This not only saves scarce federal/state health care dollars, but protects the health and rights of American children in low-income families.

Action

  1. Call your county Social Services. Ask for name, phone and address of your state Medicaid Director/Consultant.

  2. Call the Medicaid Director/Consultant and be prepared to take written notes regarding the person’s name, date and time called and what they tell you. Ask if routine infant circumcision is covered by Medicaid in your state. In any case, request a copy of their guidelines for payment/non-payment of services and their circumcision policy.
    1. If Medicaid DOES pay for RIC, ask him/her what information or guidelines were used to make this decision. When was the policy made? When was it last reviewed?
    2. If Medicaid DOES NOT pay for RIC, ask him/her for the conditions under which Medicaid WILL cover circumcision. In many states, the child must be "diagnosed" with a "condition," such as PHIMOSIS (non-retractile foreskin, which is normal), PARAPHIMOSIS (foreskin stuck behind glans, can be easily cured by compressing glans), BALANITIS (inflammed glans, iatrogenic - doctor induced - from forced retraction), FACILITATES HYGIENE (specious claim, American Academy of Pediatrics states intact hygiene is easy), REDUNDANT FORESKIN (almost all babies have a foreskin "overhang" that they grow into, normal condition), STD (VD) PREVENTION (specious claim, circumcision does not prevent venereal disease), PREVENTS URINARY TRACT INFECTION (specious claim, circumcised boys also get UTI, easily treated with antibiotics), PARENTAL PREFERENCE (specious claim, circumcision is non- essential, elective and cosmetic surgery).

  3. If your state Medicaid pays for RIC for any reason, call the Health and Human Services Fraud Hotline (1-800-447-8477) and report the Medical Director/Consultant for fraud of authorizing payment for routine infant circumcision or for circumcision under conditions which are normal, iatrogenic or specious. Your fraud report will be tape recorded and transcribed. It is recommended that you follow-up this report in writing to the HHS Inspector General, P.O. Box 23489, Washington DC 20026. Include copies of your state’s payment/non-payment guidelines, their circumcision policy, notes from your talk with the Medical Director/Consultant, and any material you have documenting why covered "conditions" are normal, iatrogenic or specious. [If you lack such materials, contact Jody McLaughlin, Medicaid Circumcision Fraud Report Coordinator, P.O. Box 209 Minot, ND 58702 (Tel. 701-852-2822).
    1. Ask how long the investigation will take (probably 6 months to a year)
    2. Your report will be given a Control Number. Include this number when you send your written fraud report and supporting documentation to the HHS Inspector General.
    For clarification of this process, contact Jody McLaughlin, Medicaid Circumcision Fraud Report Coordinator, P.O. Box 209 Minot, ND 58702 (Tel. 701-852-2822. Send her a copy of your report and any responses you receive.
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