Crackdown on NDIS fraud: What you need to know.

The NDIA has recently released a series of communications about compliance and fraud. The Agency sees detecting and prosecuting fraud as essential to maintaining the integrity of the NDIS.

While most providers and participants willingly comply with the scheme’s requirements, all providers are encouraged to review the Code of Conduct regularly to ensure they’re operating within the regulations.

Today, we’re looking at the code and the NDIA’s key fraud-related information, so you’re across the important details.

What is fraud?

Fraud is defined as “dishonestly obtaining a benefit, or causing a loss by deception or other means.”

To be considered fraud, there needs to be intent to deceive, differentiating fraud from carelessness, actions or error. A fraudulent act leads to a direct or indirect benefit or advantage. A good example is the intentional misuse of NDIS funds for personal use.

Fraud and the NDIS.

The NDIS provides some examples of provider fraud that should be reported which we share below.

Concerns about how a provider conducts business, such as:

• Falsification of invoices
• Having unsuitable or unqualified personnel providing services
• Using NDIA or NDIS branding to mislead participants
• Providing supports without the consent of the participant.
• Under-servicing a participant (charging for one hour, but only delivering 40 minutes of support)
• Altering the dates of supports provided (e.g. to a weekend) to increase the rate charged
• Charging for supports that were never provided
• Charging for one-to-one rates for supports delivered to a group
• Charging for supports provided prior to plan approval
• Charging unreasonable amounts/time for travel.

Eligibility for registration as an NDIA registered provider:

• Using misleading information in order to obtain registration status (e.g. not holding the appropriate qualifications to provide the services offered or falsely claiming to hold a higher intensity support qualification than is held).

NDIA or NDIS fraud is a crime. All suspected cases are investigated and may be subject to prosecution.

Breaches of the code.

NDIS providers are expected to meet the code and take steps to ensure workers adhere to the code.

As a provider. you must investigate and take appropriate action to address any breaches. It’s worthwhile ensuring all staff and contractors are familiar with the code as they can be liable for breaches along with the employing organisation.[1]

Fraud detection initiatives include:

• Tip-offs through the fraud reporting hotline (1800 650 717) and email address ndisfraudreporting@ndis.gov.au
• Data matching with commercial and government sources such as registries of Births, Deaths and Marriages, and analytics
• Intelligence and information sharing.

Compliance and enforcement.

Four principles guide the NDIA’s approach to compliance:

1. Participant-focused: Ensuring participants receive their full entitlements, including choice and control over planning activities
2. Risk-based: Prioritisation is based on the seriousness and nature of each matter
3. Proportionate: Compliance and enforcement activities will be equivalent to the risk being managed.
4. Deterrence: Decisions will consider the need to deter a recurrence of serious risks and wider deterrence of organised exploitation.

The NDIA also supports voluntary compliance through education and engagement.[2]

Enforcement actions may include:

• Criminal prosecution: Fines and jail time may apply for proven breaches
• Administrative actions such as suspension of plans, cancellation or suspension of nominee appointments
• Consideration of registration; Where there are quality or safety concerns or other matters relating to a provider’s suitability for registration, this may be escalated to the NDIS Commission for consideration
• Debt recovery: Claims for payments that are not legitimate may be cancelled. Funds that are not spent in accordance with a participant’s plan may be recovered.

Register of actions.

The NDIS Provider Register includes information about compliance and enforcement actions taken by the NDIS Commission including banning orders, compliance notices and suspensions of registration.

Both registered and non-registered providers can be added to this list, which is updated regularly. It’s a good idea for clients to review the list before signing up for new services. The Agency proactively contacts participants whose entitlements may have been adversely affected by non-compliance or fraud.

Reporting suspected fraud.

Anyone can make a complaint about supports and services funded by the NDIS including alleged breaches of the code.

It is essential to supply clear information to clients on how to report complaints and have a formal complaint handling procedure so any issues that arise have an opportunity to be resolved before escalating.

The NDIS Code of Conduct.

Most providers will be aware of the NDIS Code of Conduct, a document that outlines the expectations of NDIS providers and workers in terms of safe and ethical service delivery.

The code applies to both registered and unregistered providers and their employees, as well as local area coordinators.

The NDIS Code of Conduct – Guidance for NDIS Providers is a helpful guide for providers to understand how the code may be applied, including example scenarios.

Providers should regularly review governance, employee engagement, training, operational policies and procedures to ensure compliance with the code.

Image: The NDIS Code of Conduct. Source: NDIS Quality and Safeguards Commission, NDIS Code of Conduct (NDIS Providers).

More information.

• NDIS Fraud strategy
• Compliance and Enforcement Framework (download)
• Reporting suspected fraud
• NDIS Code of Conduct – Guidance for NDIS Providers 

[1] NDIS Quality and Safeguards Commission, NDIS Code of Conduct (NDIS Providers), p.32, accessed 19 August 2021.
[2] NDIS, Compliance and Enforcement Framework, p. 11. March 2020.

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