7.3 Scheme Integrity

7.3.1 Impact of fraud and corruption

When people think about the impact of fraud, they typically think about the financial cost of fraud. Fraud does have a large financial cost, but also has impacts in other areas, including the Government, your business, the community and yourself. All of these can impact you as a provider and can jeopardise the sustainability of the NDIS. 

It is in everyone’s best interest – participants, providers and the broader Australian community - that fraud and misuse are prevented within the NDIS.  

7.3.1.1 Cost of fraud

Fraud costs Australians $6 billion a year, making it the most costly crime to the community. Over $1 billion of this is against the Australian Government. 

Fraud now accounts for $1 in every $8 of crime-related costs in Australia.

Reported cases of fraud have increased. In the six months to September 2016 there were 2.5 times more cases of fraud compared to the same period in 2015. 

7.3.1.2 Impact on your business

Impacts on your business can include:

  • damage to reputation and credibility (e.g. Participants no longer want to use your services)
  • loss of resources (e.g. loss of money due to having to pay large fines)
  • loss of sensitive information (e.g. losing confidential data due to an employee disclosing it to someone).
7.3.1.3 Impact on the NDIA

Impacts on the NDIA can include: 

  • loss of public confidence 
  • undermines the integrity of NDIA information and services (e.g. people may not feel safe with the NDIA having their confidential information)
  • hinders the implementation and damages the effectiveness of the NDIS 
  • loss of resources (e.g. less money available in the NDIS)
  • decrease in staff morale.
7.3.1.4 Impact on the community

Impacts on the community can include: 

  • reduces the funds available for delivering public goods and services, such as the NDIS
  • facilitates other criminal activity, including organised crime 
  • may result in risks to public health and safety (e.g. if providers are not adequately qualified to be providing the services they are).
7.3.1.5 Impact on you personally

Personal impacts may include:

  • criminal prosecution 
  • being sued through civil action
  • loss of job, loss of income, demotion and/or loss of official entitlements such as superannuation.

 

7.3.2 Responsibilities of providers within the NDIS relating to Scheme integrity

Ensuring Scheme integrity is the responsibility of everyone engaged with the NDIS to protect against misuse and fraud. Your responsibilities to ensure Scheme integrity within the NDIS include:

7.3.3 How can I report fraud, corruption or misuse?

You should report your suspicions as soon as you reasonably believe a suspicious activity is occurring. 

Do not conduct an investigation yourself!

Waiting for more information or making further inquiries yourself may put confidentiality at risk or impair the investigation that follows.

Having a suspicion about a dishonest or unlawful act is sufficient justification to report the matter for investigation as long as your suspicion is reasonable and impartial. 

There are many channels you can use to report fraud or misuse. Your choice of channel may depend on the type of incident you wish to report. 

7.3.3.2 If you not happy with the NDIA (not related to fraud or misuse)

The Commonwealth Ombudsman investigates complaints from people who believe they have been treated unfairly or unreasonably by an Australian Government Agency or an organisation contracted to deliver services on behalf of the government.

The Commonwealth Ombudsman can be contacted at:

1300 362 072 (Calls from mobile phones at mobile phone rates)

If you are a non-English speaking person, we can help through the Translating and Interpreter Service (TIS) on 131 450.

If you are deaf, or have a hearing impairment or speech impairment, contact us through the National Relay Service:

TTY users phone 133 677 then ask for 1300 362 072

Speak and Listen users phone 1300 555 727 then ask for 1300 362 072

Internet Relay users connect to the National Relay Service then ask for 1300 362 072

7.3.3.3 If a participant is not happy with a product you have provided

The Australian Competition & Consumer Commission (ACCC) provides information about consumer rights, and accepts complaints about businesses that may have breached the Competition & Consumer Act 2010.

The ACCC can be contacted at: 

1300 302 502, Monday to Friday from 8.30am to 5.30pm AEST

The consumer protection agencies for your relevant state also can provide information about consumer rights, accept complaints about businesses and can assist in identifying the issues in dispute and exploring options to resolve the situation

Consumer protection agencies by State are:

  • Access Canberra
  • NSW Fair Trading
  • NT Consumer Affairs
  • Office of Fair Trading Queensland
  • SA Office of Consumer and Business Services (CBS) 
  • Tasmanian Consumer Affairs & Fair Trading
  • Consumer Affairs Victoria (CAV) 
  • WA Department of Commerce
7.3.3.4 If you or a participant is not happy with a disability service

There are a number of national and local state and territory agencies that can provide you information about your rights and assist with enquiries or complaints about disability services.

NSW - NSW Ombudsman

Provides advice and assistance in the resolution of complaints about disability services

NSW - NSW Health Care Complaints Commission 

Handles complaints about health service Providers and provides advice on how to resolve any concerns directly with a health service Provider without the need to make a formal complaint

VIC - Disability Services Commissioner

Provides advice and assistance in the resolution of complaints about disability services

QLD - Office of the Health Ombudsman

Handles complaints about health services and health service Providers, and helps resolve complaints between customers and Providers

SA - Disability Advocacy & Complaints Service of South Australia

Provides support, information and advocacy for people with disability, their families, friends and carers

NT - Health & Community Services Complaints Commission

Helps resolve complaints about disability and health services

ACT - ACT Disability & Community Services Commissioner

Helps resolve complaints about disability services

WA - Health and Disability Services Complaints Office

Offers a free impartial resolution service for complaints relating to health, disability or mental health services in Western Australia and the Indian Ocean Territories

TAS - Health Complaints Commissioner

Helps resolve complaints about health services and health service Providers, including some disability services and disability service Providers

 

7.3.4 Reviews

The NDIS has a range of mechanisms for detecting fraud, corruption and misuse. These include:

  • audits 
  • data mining/matching and analysis 
  • receiving referrals from other entities and sharing information with them
  • payment monitoring and reviews (regular, random, targeted)
  • internal and external reporting mechanisms (tip offs to fraud reporting hotline and email).

The NDIA conducts random periodic reviews on NDIS compliance with providers and participants. This involves conducting audits and risk assessments for fraud, misuse and conflict of interests.

Support providers may be assessed on their invoicing activities with NDIS participants to validate the existence, quantity and rate of claims. 

All incidents of suspected or potential fraud or corruption committed by staff, participants and providers are assessed by the NDIA Scheme Integrity team.

7.3.5 Consequences

Suspected fraud or misuse will be further investigated by the NDIA and further action may be taken against providers, participants or NDIS staff found to be non-compliant with their obligations.

If someone is found committing fraud, corruption, misuse or fails to declare a conflict of interest there can be serious consequences. Consequences can range from loss of job, conviction in a criminal or civil court, acquisition of a criminal record or jail. 

Failure of providers to adhere to the NDIS Terms of Business could result in evaluation and revocation of their status as a registered provider. 

Claims that are found to be unsupported by the documentation retained by providers may need to be repaid to the NDIA.


Last modified 29/11/2017

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