DOCUMENT 1
Our Reference: Response to FOI 22/23-0351
FOI 22/23-0351
Scope
- The number of claims from unregistered providers have the NDIA cancelled and the total dollar amount of these claims. For context, in the 2021-22 FY, the quarterly report states the NDIA cancelled approximately $44.8 million worth of non-compliance payments, across 38,700 claims, but I cannot see disaggregated data on unregistered providers.
- The number** of unregistered providers are currently under investigation for fraud
- The total dollar amount of fraud the NDIA alleges by unregistered providers under investigation at today’s date
- Of the 66% of Plan Management providers that overcharged participants and subsequently cancelled payments (QR 2022, p140), what was the average amount cancelled
- Modelling or research completed or commissioned by the NDIA or the Commission about the percentage of scheme’s payments lost to fraud by unregistered providers
- How many FTE positions are currently filled in the NDIA’s Compliance Response Team
- How many FTE positions are currently filled in the CRT, broken down by SES, EL, and APS 4-6 positions
- Annual budget for the Compliance Response Team for 2022-23
Response
-
The number of claims from unregistered providers have the NDIA cancelled and the total dollar amount of these claims. For context, in the 2021-22 FY, the quarterly report states the NDIA cancelled approximately $44.8 million worth of non-compliance payments, across 38,700 claims, but I cannot see disaggregated data on unregistered providers.
The NDIA does not currently pay unregistered providers directly. Depending on how a participant chooses to manage their plan the NDIA will make payment of claims directly to NDIS registered provider, Plan Management Agents or participants who are Self-Managed.
-
The number** of unregistered providers are currently under investigation for fraud
A total of 13 unregistered providers are involved in current investigations. Seven of these are involved in matters currently under prosecution.
-
The total dollar amount of fraud the NDIA alleges by unregistered providers under investigation at today’s date
The total suspected fraud value for current investigations involving unregistered providers as at 7 September 2022 is $6,809,720.
Page 1 of 2
Our Reference: Response to FOI 22/23-0351
-
Of the 66% of Plan Management providers that overcharged participants and subsequently cancelled payments (QR 2022, p140), what was the average amount cancelled
The average value of cancelled payments was $386. At the individual Plan Management Agent value, the average cancellation total was $3,239.
-
Modelling or research completed or commissioned by the NDIA or the Commission about the percentage of scheme’s payments lost to fraud by unregistered providers
The NDIA conducts sample testing of 100-150 claims per month, randomly selected across all claimants and claim types, including those made by unregistered providers. Of the 1,436 claims reviewed in 2021-22 financial year, 21 from unregistered providers were found to be erroneous claims. Note, these were not necessarily fraudulent as errors may be intentional or unintentional.
-
How many FTE positions are currently filled in the NDIA’s Compliance Response Team
The Compliance Response Team has 33 Full Time Equivalent (FTE) positions. Of these, 29 positions are currently filled as at 6 September 2022.
-
How many FTE positions are currently filled in the CRT, broken down by SES, EL, and APS 4-6 positions
Of the 29 FTE positions currently filled in the Compliance Response Team:
- 1 x SES (responsible for five teams including the Compliance Response Team)
- 2 x Executive Level (EL2 and EL1) equivalents
- 26 x APS4-6 equivalents.
-
Annual budget for the Compliance Response Team for 2022-23
The Compliance Response Team’s estimated budget for 2022-23 is $3.4 million.
Page 2 of 2