Phony phimosis – medical fraud

Physicians examining C.R.N.H. should be warned that they are being observed by thousands of activists, several intactivist organizations, the national and international media and the international community, and any fraudulent referral over “phimosis” will no doubt lead to reports of misconduct and ethics complaints.

In 2013, Dr. Saleem Islam published a study called: “Allocation of Healthcare Dollars: Analysis of Nonneonatal Circumcisions in Florida“, indicating that the cost of circumcisions in the state of Florida had “skyrocketed” since Medicaid stopped covering neonatal circumcisions.

Islam explained: “Parents often explained that they were unable to pay for the procedure after the child was born. We hypothesized that neonatal circumcisions were deferred among families in lower socioeconomic classes because public funding was not available. Circumcisions would then be done when the child was older, a costlier procedure requiring general anesthesia in an outpatient surgical facility.”

After the age of 1, circumcision is a more complex procedure and up to 20 times more expensive, now requiring general anesthesia. The risks also grow by 20 times, according to the CDC’s Charbel El Bcheraou.

Islam wrote: “Our data show the cost of nonneonatal circumcisions in Florida has more than doubled over the 5 years studied, the apparent result of defunding nonneonatal circumcisions. Our experience suggests that parents continue to want the procedure done in early childhood because of the availability of public financing. If public funding were available for the procedure in the neonatal period, they would have had the procedure done then.

But here’s where things go wrong. Neonatal circumcision was defunded because it was an elective, non-essential procedure. In order to obtain a referral and funding for a non-neonatal circumcision, the physician needs to provide a diagnosis – and this diagnosis is usually phimosis or congenital non-retractable foreskin. But the diagnosis of phimosis at that age is usually wrong because the foreskin at that age is not supposed to be retractable.

There is debate over what really constitutes phimosis. Some experts suggest that real phimosis is characterized by lesions caused by BXO – balanitis xerotica obliterans, not just the inability to retract the foreskin.

Øster showed that at age 10, less than 50% of the boys become capable of retracting their foreskins, but between 16 to 17 years close approximately 95% can retract. Thus, diagnosing non-retractable foreskin of a child as “phimotic” and referring to circumcision interrupts the normal development cycle of the foreskin and results in loss of normal healthy genital tissue.

The World Health Organization has made this travesty simpler  by codifying a normal condition as a disease: ICD-10-CM code N47-0 corresponds to “Adherent prepuce of newborn” – and it is a diagnosis that applies to males only. Other related diagnosis continue the N47 series, including phimosis, paraphimosis, deficient prepuce, etc.

Physicians consciously commit fraud when they refer a child for circumcision over a diagnosis of “phimosis”. By playing into the “wants” of the parents, the “tradition”, the cultural or religious arguments, or parental preferences, physicians ignore their duty to their patient and become cultural or religious brokers, referring a non-consenting patient to genital surgery without any real medical indication. This clearly shows that circumcision of children in the United States is nothing but a medical ritual, a harmful traditional practice affecting the health of the boy child – to paraphrase an expression used by the World Health Organization.

As we denounced two years ago, some medical institutions even today, check intact (uncircumcised) boys for retraction during their well checkups, and “offer the option of circumcision” – in what may be perceived by the parents as a recommendation.

Nebus vs Hironimus

This information is particularly relevant to the case of Nebus vs Hironimus, which we have covered in detail this last year. In 2014, Nebus argued that his son, C.R.N.H., suffered phimosis and it was causing him to urinate on his legs. A medical expert testified that C.R.N.H. did not have phimosis and had no medical need for circumcision – a testimony that was cherrypicked by Judge Gillen to suggest that the “benefits” of circumcision were enough to justify enforcing the parental agreement, ignoring the increased risks and fears and the child’s opinion.

Now that Hironimus has been forced to sign a “consent” form (under the threat of indefinite incarceration) and Nebus has been granted wide power to schedule the procedure, in or out of state, and without warning Hironimus in advance or afterwards, the next step is clear: Nebus will seek a referral for circumcision arguing “phimosis” – so that Medicaid or any applicable health plan will pay for the procedure.

Physicians examining C.R.N.H. should be warned that they are being observed by thousands of activists, several intactivist organizations, the national and international media and the international community, and any fraudulent referral over “phimosis” will no doubt lead to reports of misconduct and ethics complaints.

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