Escalate application integrity issue | FOI document library

FOI 24/25-1473 DOCUMENT 40

Escalate application integrity issue SGP KP Publishing

              Exported on 2025-04-02 22:30:47

SGP KP Publishing – Escalate application integrity issue

Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Identify integrity issues …………………………………………………………………………………………. 6 4 Understand Access Integrity Management team …………………………………………………….. 9 5 Action an integrity issue ……………………………………………………………………………………… 10

                                                                       Table of Contents – 2

SGP KP Publishing – Escalate application integrity issue

This article provides guidance for an access delegate to: * identify an integrity issue * understand Access Integrity Management’s (AIM) role * action an integrity issue.

                                                                     Recent updates – 3

SGP KP Publishing – Escalate application integrity issue

1 Recent updates

October 2023 Current guidance .

                                                                     Recent updates – 4

SGP KP Publishing – Escalate application integrity issue

2 Before you start

You have: * read and understood Our Guideline – Applying to the NDIS * been following guidance in article How to apply to the NDIS in PACE * have read and understood the Fraud Strategy Statement.

                                                                           Before you start – 5

SGP KP Publishing — Escalate application integrity issue

3 Identify integrity issues

If you see an application or evidence document that may not be genuine or real, this is an integrity issue.

An integrity issue may be something you notice during your check of an application for consent or evidence provided for:

treating professional information
disability evidence.

The following table provides information on where you may find an integrity issue:

Issue	Query	Resolution
NDIS applicant consent	Does applicant have capacity to provide consent or has a legal authorised representative to act on their behalf?	Yes — no issue. No — the applicant is unable to consent and does not have a legal authorised representative — integrity issue — escalate
Treating professional information	Can you confirm their qualifications and registration with AHPRA?	Yes — no issue. No — AHPRA confirmation — integrity issue — escalate
Treating professional information	Do they have a correct professional title?	Yes — no issue. No — errors in title or when confirming identity of the applicant — integrity issue — escalate
Treating professional information	Is their contact information different to the applicant?	Yes — no issue. No — phone number, email, address is same as applicant — integrity issue — escalate
Treating professional information	Is their contact information from a business?	Yes — no issue. No — they are using a personal email address (@gmail, @hotmail, @outlook, @msn, @live) — integrity issue — escalate
Treating professional information	Do they have a legitimate business address for a treating professional?	Yes — no issue. No — from an online search with open-source information, the address appears as another business — integrity issue — escalate
Treating professional information	Does their qualification align with the diagnosis?	Yes — no issue. No — diagnosis provided does not align with their qualification — integrity issue — escalate

Identify integrity issues — 6

SGP KP Publishing — Escalate application integrity issue

Issue	Query	Resolution
Disability evidence	Is the impairment diagnosis done by an appropriate treating professional? For example — applicant approached a new GP to report an impairment. However, GP has not confirmed the impairment with another treating professional or done their own assessment.	Yes — no issue. No — impairment is self-reported — integrity issue — escalate
Disability evidence	Do they use current terminology and assessment tools? For example — a recent report references the DSM-5	Yes — no issue. No — outdated terminology and assessment tools — integrity issue — escalate
Disability evidence	Is the disability evidence completed by a treating professional?	Yes — no issue. No — evidence is self-reported — integrity issue — escalate
Disability evidence	Are documents professional?	Yes — no issue. No — spelling errors, incorrect grammar, improper language, lack of appropriate detail, or language style change in document — integrity issue — escalate
Disability evidence	Do documents include the applicant’s name with correct spelling?	Yes — no issue. No — document has someone else’s name and/or have mis-spelled names — integrity issue — escalate
Altered documents	Are documents unchanged? For example, liquid paper (white out) used to remove document information.	Yes — no issue. No — document text may be removed, added or changed — integrity issue — escalate
Altered documents	Are documents written in a consistent font typeface (font size and type) with aligned paragraphs?	Yes — no issue. No — inconsistent font types, font sizes, text, and paragraph misalignment — integrity issue — escalate
Altered documents	Are documents easy to read?	Yes — no issue. No — hard to read, poor quality from repeated scans and photocopying — integrity issue — escalate
Altered documents	Are documents complete?	Yes — no issue. No — partial documents received from the treating professional — integrity issue — escalate

Identify integrity issues — 7

SGP KP Publishing — Escalate application integrity issue

Issue	Query	Resolution
Altered documents	Are documents locked (PDF, scanned or protected) for editing?	Yes — no issue. No — documents can be edited — integrity issue — escalate
Conflict of interest	Is the provided disability evidence independent of the NDIS?	Yes — no issue. No — treating professional may benefit from applicant becoming a participant — integrity issue — escalate
Conflict of interest	Has there been a reasonable level of provider contact about this application?	Yes — no issue. No — excessive and repeated provider contact, who may benefit from applicant becoming a participant — integrity issue — escalate
Conflict of interest	Is the treating professional’s name different to applicants?	Yes — no issue. No — treating professional has a similar name and could be related to applicant — integrity issue — escalate
Conflict of interest	Has applicant made less than 2 applications?	Yes — no issue. No — applicant has put in more than 2 applications and each time changed primary disability — integrity issue — escalate

Identify integrity issues — 8

SGP KP Publishing – Escalate application integrity issue

4 Understand Access Integrity Management team

The Access Integrity Management (AIM) team are responsible for investigating and making a recommendation to the access delegate and team leader about an integrity issue. You should follow up to try and resolve the potential integrity issue first. If this does not occur after receiving further information regarding the application refer the issue to the AIM team for investigation.

                                           Understand Access Integrity Management team – 9

SGP KP Publishing – Escalate application integrity issue

5 Action an integrity issue

To report an integrity issue, use these email templates: * Introduction

Hello , I have identified a potential integrity issue. I refer this to you for your advice and/or escalation to the Access Integrity Management team. Please see the details below:

Part 1: referral reason - Access assessor to complete

Applicant’s name: NDIS number: Date of birth: Decision due date: Special circumstances (select all that apply): ☐ Aboriginal and Torres Strait Islander people (ATSI) ☐ Child Protection ☐ Culturally and Linguistically Diverse backgrounds (CALD) ☐ Ministerial ☐ Remote / Very Remote ☐ Other: Click or tap here to enter text. Reason for referral (select all that apply): ☐ Evidence of disability – Health professional’s qualification and/or registration ☐ Evidence of disability – signs it may not be genuine ☐ Evidence of disability – signs of altered documents ☐ NDIS application consent ☐ Conflict of interest ☐ Other: Click or tap here to enter text. Details: <Provide all relevant details about the issue, including references to relevant documents, interactions, and NDIS business system fields.> You may use or adapt integrity issues from this knowledge article, or write your own reason/s.

Part 2: reply to access assessor – Team Leader to complete if an AIM referral is not required.

Hi Thank you for escalating this potential integrity issue. Please see my response below: Referral: Actions and findings:

                                                                       Action an integrity issue – 10

SGP KP Publishing – Escalate application integrity issue

<Summarize activities, reference sources, advice etc.> For example, attempted 3x to contact Health Practitioner; HP contact details on website x@y.com are different to what’s on the report; unable to confirm whether report is genuine. For example, independently searched contact details for HP, called them to ask why there are three different patient names in their report; they advised it was admin error. They will send a new report directly to NAT mailbox. Recommendation: ☐ Accept the document/information – I have verified it is genuine and correct. Please progress with the access decision. ☐ Access Assessor to take these steps to verify the document / information and progress the access decision: For example, please do independent search for health professional’s contact details and make direct contact with them. If the matter is not resolved after taking these steps, re-submit access integrity issue to Team Leader. ☐ I have referred this matter to Access Integrity for further assessment and recommendation. Please wait for the outcome before progressing the access decision. Comments (optional):

Part 3: referral to AIM – Team Leader to complete (if required)

Email: redacted: [s47E(d) - certain operations of agencies](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-015__47e-d-certain-operations-of-agencies/) @ndis.gov.au Hello Access Integrity Management Team, Please see the below referral: Referral: Additional comments or questions to be answered: Evidence, documents and information: What other information should be considered? Where is it located in the NDIS business system? <Please list all relevant references (for example, interaction dates, NDIS business system fields etc)>

Part 4: response and recommendation to business area – AIM to complete

Hello , Thank you for your referral. Please see our response below: Actions and findings: <Summarise activities, reference sources, advice etc> For example, attempted 3x to contact Health Practitioner; HP contact details on website x@y.com are different to what’s on the report; unable to confirm whether report is genuine.

                                                                       Action an integrity issue – 11

SGP KP Publishing – Escalate application integrity issue

For example, an independent search of contact details for HP, called them to ask why there are three different patient names in their report; they advised it was admin error. They will send a new report direct to NAT mailbox. Recommendation: ☐ Accept the document/information. I have verified it is genuine and correct. Please progress with the access decision. ☐ Team Leader / Access Assessor to take steps to verify the document / information and progress the access decision: For example, please independently search for health professional’s contact details and contact them directly. If the matter is not resolved after taking these steps, re-submit access integrity issue to AIM. ☐ DO NOT Accept the following document/information: Click or tap here to enter text. It is not likely to be genuine and/or correct. Comments (optional): IF not accepting, AIM will send a letter/s (AIM SOP) Kind regards,

                                                                       Action an integrity issue – 12