When a significant amount of money is invested in something, the risk of fraud typically increases. Which is why it comes as no surprise that a scheme as financially big as the NDIS has been the talk of the town when it comes to fraud and compliance. So, what can we expect when it comes to fraud, compliance, and red flags to watch out for?
Fraud vs non-compliance
Fraud is considered to be a specific and intentional crime involving individuals or organisations falsely claiming to provide services to NDIS participants or inflating their services' costs.
Whereas non-compliance can lead to mistakes when it comes to adhering to the regulations and standards set by the scheme for providing services to participants. Compliance ensures that participants receive quality services that meet their needs while avoiding fraudulent activities.
It’s essential to maintain a balance between NDIS compliance and fraud prevention to ensure the scheme's success and the well-being of its participants.
It was recently announced by the NDIS Minister Bill Shorten, that the NDIS is set to go through a reboot aimed at improving the quality of services and support provided to people with disabilities, reducing bureaucratic red tape, and making it easier for people to access the NDIS.
One of the key policy directions that has been laid out is to eliminate unethical practices. Essentially this means continuing the crackdown against fraud and unethical behaviour.
The term ‘fraud crackdown’ is nothing new to the NDIS, with the fraud taskforce having been in full swing since being established by the Australian government in 2018 to tackle fraud and abuse of the NDIS.
The aim of the taskforce is to identify and investigate instances of fraud, particularly those related to fraudulent claims made by NDIS providers or participants. The taskforce’s work includes analysing data to identify potential fraud, conducting investigations, and prosecuting cases where appropriate.
They also work to raise awareness of fraud and abuse in the NDIS and provides education and guidance to participants, families, and providers about how to prevent fraud and report suspicious activity.
Red flags to watch out for
As a participant, there are some red flags you can be on the lookout for to help protect yourself against fraud, including:
#1 Refusing service agreements
The best protection from criminal activity or shady providers is to have a written contract in place that can protect you if things go wrong. It’s always a good idea to talk with your providers about setting up a service agreement. It’s important to note that only NDIS registered providers are required to have a service agreement in place. So, if a provider isn’t NDIS registered, not having a service agreement isn’t necessarily red flag worthy. However, if a provider (registered or non-registered) actively discourages or refuses to set up a service agreement, that can be considered a red flag. After all, having a service agreement in place benefits both providers and participants.
#2 Making changes
Making unexpected changes to your supports or services that hasn’t been discussed with you or isn’t listed in your service agreement can be a red flag. If an unexpected change has occurred, talk with your provider first to determine why the change was made without discussion. If you still have concerns, speak with your support coordinator, plan manager or LAC to determine next steps.
#3 Asking too much about your funding
Now, it’s not completely out of the ordinary for a provider to ask questions about your funding. Providers do need to be confident that they will be paid for their work. However, if a provider wants to know how much funding you have before they have discussed your support needs to draw up any agreements or quotes… this is a potential red flag. The NDIS does not recommend sharing specific budget details with providers. If a provider has a question regarding funding, normally it might be to check that there is funding available for their supports and services and maybe how many hours of funding you potentially have – not a dollar amount.
Tips for compliance
When it comes to compliance, there are three major tips that can help keep you on the right path. They are:
Keep records of all documentation including reports, medical records, copies of your previous plans, essentially any documentation relevant to your disability and NDIS plan.
Ensure all invoices and receipts align with NDIS requirements.
If you are plan managed by us, we can help keep track of service agreements and your invoices.
How we can help
Our goal is to help participants exercise their choice and control over invoicing, including being able to approve or reject invoices where necessary, and being able to easily access a real-time review of their budgets and previously paid invoices. You can maintain maximum choice and control through our flexible invoice payment options.
If you ever have concerns about fraudulent activity, especially relating to your invoices, reach out to our team on 1300 233 273 or email firstname.lastname@example.org.