- Fraud and compliance
Compliance is good for everyone. It
- stops participants paying the wrong amount
- makes the market fair for participants
- creates a level playing field for providers
Home and living compliance means following the rules in the NDIS Pricing Arrangements and Pricing Limits and previous NDIS Price Guides.
Registered providers agree to follow these rules. Every time providers make a claim for payment in the myplace provider portal they confirm they followed the rules.
Compliance is a provider’s responsibility and we will work with you to ensure you are compliant.
- Checking if participants are paying more than they should for supported independent living supports
- Checking if participants are paying for TTP supports when also paying for supported independent living supports
- Checking if participants are paying for specialists disability accommodation in advance
- Checking if participants are paying for shared supports they don’t receive
Providers should not ignore any contact we make. Always respond by the due date to avoid any escalated action.
Results and insights from past activities
The NDIA started home and living compliance activities in March 2021, checking if participants paid more than they should for supported independent living supports.
What we did
- wrote to providers if they may have overcharged a participant by more than $20,000. We asked them to review their claims for payment and make sure they had not made a mistake
- had the money repaid when a participant was overcharged.
What we found
- participants paid $16 million more for their supported independent living supports than they should have
- most providers did not understand when the price is set by quote the maximum price they can charge a participant is the approved quote amount
- many providers incorrectly think the service booking sets the maximum price
- some providers incorrectly think they are entitled to all the money in the service booking no matter how much support they provide the participant
- providers sometimes give more support than covered by the approved quote and charge participants for this support without knowing the participant will be able to pay for it
How you can make sure you comply
- Understand the rules set out in the NDIS Pricing Arrangements and Price Limits and make sure your workers know compliance is important
- Write down business and financial practices to help you to comply and train your workers in these practices
- Check your business and financial practices to make sure they work and you comply
- Fix any non-compliance you find and make improvements to prevent future non-compliance
- Update your written business and financial practices when the NDIA changes its pricing arrangements and price limits
- Keep good records to show you comply