The NDIS Fraud Strategy Explained

Reading Time: 3 mins

The NDIA’s fraud control arrangements exist to protect the scheme and the misuse of NDIA funds intended to support people with disability. In this article we explain the NDIS fraud strategy in detail including how providers can ensure they’re operating within the NDIS’ Code of Conduct.

What is fraud?

Fraud is defined as ‘dishonestly obtaining a benefit or causing a loss by deception or other means.’ Fraud is a crime. It requires intent, which is more than carelessness, accident or error.

To classify an activity as fraud, it must be deliberate and lead to a direct, or indirect benefit or advantage, to an individual or group. A benefit is not restricted to a material benefit and may be tangible or intangible, including information. The benefit, or advantage, may not necessarily be for the person committing the fraud; a benefit may be received by a third party.

Fraud in the NDIS and NDIA

Fraud that implicates the NDIA could include:

theft
unlawful disclosure of official information
accounting fraud (e.g. false invoices)
fraudulently claiming leave, travel and other entitlements
misuse of assets, equipment or other facilities.

Fraud that implicates the NDIS could include:

obtaining and using NDIA information or restricted data
providing false information
making claims for payment for services or products that were not provided
use of fraudulent documents
theft.

Some examples of reportable provider fraud include:

The manner with how a provider manages their business, such as:

Alteration of invoices
Using unqualified personnel to provide services
Using NDIA or NDIS branding to mislead participants
Providing supports without the consent of the participant
Providing less support than what is paid for

Altering the dates of supports provided to increase the rate charged
Charging for supports never provided
Charging individual rates for supports delivered to a group
Charging unreasonable amounts 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 support qualification than is held).

All alleged cases are investigated and may be subject to further action.

Compliance and enforcement

There are four principles guide the NDIA’s approach to compliance:

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

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 against a provider by the Commission including bans, compliance notices and registration suspensions.

Both registered and non-registered providers can be added to this list. Clients should review the list before signing up for new services. The NDIA will contact participants whose entitlements may have been negatively affected by non-compliance or fraud.

The NDIS Code of Conduct

The NDIS Code of Conduct is a document that outlines the expectations of NDIS providers and workers covering the safe and ethical delivery of services. It 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. Providers should regularly review governance, employee engagement, training, operational policies and procedures to ensure compliance with the code.

How to report fraud

You can report suspected fraud by calling the NDIS fraud reporting and scams helpline on 1800 650 717 or by emailing: fraudreporting@ndis.gov.au

To support fraud prevention, the Agency has also developed the Compliance and Enforcement Framework. The Compliance and Enforcement Framework details the Agency’s compliance approach, enforcement objectives, activities, and roles and responsibilities.