• Claire’s story

    Claire has been speaking to a participant, Peter. Peter tells Clair that he receives NDIS funding on behalf of his 2 children, Courtney, aged 12 and Charlie, aged 9. Charlie’s NDIS-registered physiotherapist charged him for four sessions last month for Charlie, but he only attended three because one of the days fell on a public holiday. Peter has a Service Agreement with the clinic on behalf of Charlie. It does not include anything about what happens on a public holiday.

    Claire contacts the NDIA fraud reporting hotline to notify NDIA of the issue.  

     

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  • Clive's story

    Clive is contacted by a participant, Paul, that he has been servicing for several years.  Paul tells clive that he has just had his planning conversation with the NDIA. The NDIA planner recommend his own family's business for cleaning services saying they were the best in town. Paul was confused and thought he had to go with the NDIA planner's recommendation.

    Clive contacts the NDIA fraud reporting team via the hot line to discuss the potential conflict of interest.

    Illustration of man holding a bucket and a mop
  • Maraya's story

    Maraya has a chat with one of her customer service team who tell her that their competitors also own a support coordination business and that they are pressuring NDIS participants to also engage them to support participants to implement their plan. The participants are concerned that the provider is their only source of funded supports, and they want a bit more variety in the providers and people who will support them in the future.

    Maraya contacts the fraud reporting team via email highlight what she has heard.

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Identifying warning signs of potential fraud or misuse is important for early detection. The following warning signs can help identify potentially suspicious activity.

 

1. Provider or participant may be claiming for service not provided

Examples

  • provider lodging payment request when no service was provided
  • provider lodging long distance travel requests for each participant seen in a location, rather than one single long distance travel request (this is called double-billing)
  • provider lodging payment request for participants who have received group treatment for each participant separately (this is called up-coding)
  • provider changing the date of service provided on a Sunday to bill Sunday rates when the service was provided in the week (this is also up-coding)
  • provider bills for a set amount of sessions but provides fewer (this is called under-servicing)

 

2. Provider pricing for services seems wrong

Examples

  • price exceeds what is reasonable and necessary
  • providers charging above Service Agreement quotes
  • multiple prices for the same service
  • high cancellation fees

3. Provider may not have correct qualifications to be providing services

Examples

  • a provider who is unqualified (by the relevant registration body) to be providing the service they do
  • a provider who has a relevant qualification, but not to the level required to be providing the service
  • a provider whose qualification has lapsed or is out of date

 

4. Documentation kept, submitted or presented by provider or participant seems unusual

Examples

  • a date that the claim was paid occurring before the service was provided
  • a date the claim was made occurring before the plan was approved
  • Service Agreements that may have false signatures, no signatures or have only been signed by one party
  • branding by provider appears misleading (e.g. branding looks very similar to NDIA branding for registered providers, but provided is not registered)
     

5. Provider appears to be behaving inappropriately towards participants

Examples

  • threat of withdrawal
  • high-pressure sales
  • activity that may indicate a scam (e.g. unusual emails or calls)
  • provider asks participant for their plan before giving pricing
  • cancellation conditions in the Service Agreement are unreasonable or cancellation is not allowed by provider
  • provider is making service bookings without consent or knowledge of participant
  • provider is 'quarantining bookings' - booking sessions for participants over an unreasonable timeframe (e.g. booking participants for services for 12 months where it is not required or appropriate)

6. Possible corruption or conflict of interest between participants, providers or NDIA employees

Examples

  • kickbacks (payments or gifts) to participants, providers or employees within the Scheme
  • participant claiming with self as a provider
  • planners suggesting particular providers
  • participant colluding with related party for referrals (e.g. doctor)
  • preferential treatment of family members (this is called nepotism) or friends (this is called cronyism) by participants, providers and NDIA employees
  • theft or misappropriation of official assets
  • blackmail

How do I report suspected fraud?

Do not conduct an investigation yourself.
You can report suspected fraud or misuse directly to the NDIA.

by email: fraudreporting [at] ndis.gov.au

by calling: 1800 650 717