PO Box 87 Grange QLD 4051 | Ph: 0438947802 | Email: belinda@intrepiduslaw.com.au
30 January 2026
Committee Secretary Joint Committee of Public Accounts and Audit PO Box 6021 Parliament House Canberra ACT 2600
Via web portal
Dear Committee Secretary
Submission: Inquiry into the Administration of the National Disability Insurance Scheme
Thank you for the opportunity to provide submissions on the administration of the National Disability Insurance Scheme (NDIS). This submission focuses on ‘claimant and provider compliance with NDIS claim requirements’ per the terms of reference.
About Intrepidus Law
Intrepidus Law is Australia’s foremost NDIS and disability rights law firm. The Principal and Founder of Intrepidus Law is Belinda Kochanowska, who was awarded the prestigious Queensland Law Society Solicitor of the Year Award in 2025 and was a finalist of the 2025 Australian Human Rights Commission Law Award. Intrepidus Law has a practice focus on providing legal representation in NDIS appeals at the Administrative Review Tribunal and providing expert legal advice on NDIS law. Intrepidus Law is a private legal practice committed to reinvesting in our community through pro bono systemic advocacy.
Executive summary
The National Disability Insurance Agency (Agency) and Australian Government have been under scrutiny from the media and public, who rightly want taxpayer funds properly administrated and directed to supporting people with disability. This scrutiny has co-occurred with patchwork and reactive reforms that have made the Scheme too difficult to navigate. It is easy for well-meaning participants and providers to unintentionally claim in a way that can be characterised as misuse of a NDIS plan. This is leading to serious punitive and financial consequences for both participants and providers, often in the absence of natural justice and procedural fairness.
Page 1 of 7
Although the Agency retains responsibility for the governance of compliance, the day-to-day responsibility for ensuring compliance has been shifted to these ordinary Australians who rely on the NDIS for their lives and livelihoods. We are concerned this sets those Australians up to fail.
Where the Agency retains responsibility for investigating non-compliance, we are concerned that the Agency may be engaging in an improper use of its power under s 45 of the National Disability Insurance Scheme 2013 (‘Act’) without affording claimants natural justice and procedural fairness.
In exercising these powers, we are concerned about the impact on small businesses, women and people with disability, particularly those who are self or plan-managed participants of the Scheme. This concern arises especially out of the administrative burden that manual claims review pursuant to s 45 of the Act places on both NDIS providers and participants alike.
The Scheme is too complex for the Agency to oversee compliance
Any government service which invests taxpayer money on Australians must be accountable for its expenditure. As a society, we expect their systems to make fraudulent spending difficult to achieve and easy to detect; whether it be the Australian Tax Office, the Department of Veterans’ Affairs or the Higher Education Loan Program. But unlike these other government services, non-compliant NDIS spending is highly sensationalised in the media. Public focus is on ‘dodgy providers’ or ‘fraudsters rorting the Scheme’, when the enquiry should be on effective and robust Scheme infrastructure and administration.
The Scheme’s successful rollout saw its participant and provider base expand, alongside increasing parliamentary and media attention on the Scheme’s total cost and purpose.1 Years of patchwork changes have created an NDIS famously difficult to navigate as a participant, provider or allied health expert – and increasingly challenging for its Agency to administer and ensure compliant spending.
The most significant compliance reforms were passed with the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Act 2024 (‘2024 Amendment’). This targeted two perceived problems, that:
1. The Scheme was too expensive; and
2. Scheme money was being spent inappropriately.
The solution was creating more rules around what constitutes an ‘NDIS support’ and conditions for claiming Scheme money. The exercise of determining compliance is now overly technical and resource intensive. This makes it even less practicable for the Agency to determine compliance at scale.
1 Auditor-General Report No. 48 2024-25 National Disability Insurance Agency’s Management of Claimant Compliance with National Disability Insurance Scheme Claim Requirements, [1.1]–[1.3].
Page 2 of 7
Outsourcing responsibility to participants and providers sets them up to fail
Having built insufficiently robust infrastructure to easily detect non-compliance, responsibility has been moved to participants, nominees, plan managers and providers. We are concerned that ordinary Australians who make their lives and livelihoods on the NDIS are being set up for failure.
The 2024 Amendment effected this transfer of responsibility. These are now the matters which a participant or provider must satisfy themselves of before making a claim:
-
That the claim is for an NDIS Support under ss 10 (i.e. it is on the ‘in’ list and not on the ‘out’ list per the NDIS Rules).
-
That the claim is for money spent in accordance with the participant’s plan per s 46.
-
That the claim is in the approved form and includes any information or documents required by the CEO, per s 45A.
Failure to comply may result in the following consequences:
-
The pending claim could be rejected or indefinitely held in suspension by the Agency pending decision.
-
A non-compliant claim paid out could be recovered as a debt.
-
The Agency can amend or restrict a participant’s plan or plan management status.
Below we provide some detailed examples of how these requirements and consequences play out.
Claim rejections for self-managed and plan-managed participants
When a self-managed participant submits a claim to the Agency, that participant has already been invoiced for the purchase of the support by the NDIS provider. If the Agency rejects the claim, the self- managed participant is exposed to the NDIS provider raising a debt against them for the unpaid invoice, unless the self-managed participant pays that invoice out-of-pocket to avoid a debt. This incentivises providers to enquire about an individual participant’s financial health and capacity to pay the debt out-of-pocket prior to providing services to a self-managed participant. Since many people with disability are in financial distress or unemployed, in many cases it will be undesirable for a provider to provide services to any self-managed participant. The same risk applies for plan managed participants; however, providers may assume a false sense of comfort that plan managed claims will be automatically paid. We are not seeing this in practice, however, and the same risk profile applies to plan managed participants and claims.
Claim rejections for Agency-managed participants
Even if a provider were to only deal with Agency-managed participants, there remain numerous risks that the invoices that a provider claims directly with the Agency could be rejected, or that a debt could
Page 3 of 7
be raised after payment is made. NDIS businesses need to seriously consider whether the fiscal risk is worth engaging in, as the being caught in a s45 “manual claim review” process which results in “payment locks” significantly disrupts cash flow, particularly if your business has hundreds or even thousands of claims under “manual claim review”. As these liability risks become understood by NDIS businesses, we anticipate insurance premiums will rise and businesses will leave the NDIS market, as the risk of being subject to “manual claims review” by the Agency and its consequential strangulation on the cash flow of a business, makes providing NDIS services too commercially perilous and unviable.
Providers claiming not in accordance with a participant’s plan: s 46
The obligation on providers to only submit claims in accordance with the participant’s plan is deeply concerning from a market view. Providers must obtain consent from the participant or nominee to be provided a copy of a participant’s NDIS plan. NDIS plans include sensitive and personal information about a participant, much of which is confidential, private and sensitive. There is no easy way to hand over only the relevant part of a NDIS plan.
Once a provider has possession of a plan, understanding it is another question. These are lengthy documents, sometimes running for 40+ pages. Often one plan is structured entirely differently to another, so there is no single plan template on which a worker can be trained on how to read and understand quickly and easily.
Despite all the detail included in plans, they often do not state in enough clarity what NDIS supports are precisely funded. In building a plan, the Agency makes granular decisions about what NDIS supports are reasonable and necessary. The total hours or dollar values are tallied into categories, and only those categories reported. This frustrates the question of whether a purchase of a support is in accordance with a plan pursuant to s46.
For instance, imagine a plan which under ‘Core Flexible’ includes 8 support worker hours per week for ‘community participation’, and nothing else. Can a participant reinvest two hours on assistance with laundry and meal preparation? This flexibility is a key feature of a flexible core budget. Yet, in building that plan, the Agency may have made a granular decision that the evidence did not justify funding any assistance with daily life. There is no indication of this in the actual plan the participant or provider received – only in the Agency’s computer system. It may not have even been communicated to the participant. Yet that participant and provider may be accused of misusing the plan. The situation is expected to be even less transparent under new framework plans, which are meant to be drafted in even broader terms, with “total support budgets”.
These amendments are at cross-purposes with the foundational principles and architecture of the Scheme. The NDIS’s plan-building arm wants broadly worded plans which notionally maximise participants’ choice and control and flexibility; the Scheme’s enforcement arm incentivises providers to refuse any service not explicitly listed in the plan down to the granularity of a line item, due to the risk of punitive and fiscal consequences.
Page 4 of 7
Improper use of Agency power in manual reviews and payment locks
Whilst participants and providers are now responsible for ensuring their own compliance, the Agency retains the responsibility for holding them accountable. To do this job, the Agency has been armed with various investigatory powers. These powers have been designed by parliament to guarantee natural justice and procedural fairness: e.g. the process for obtaining an investigation warrant to access information,² the opportunities for providers to respond and ask questions during a post-payment review,³ and the criminal procedure protections afforded during a fraud investigation. Further, if a debt is raised, this may be challenged through the justice system.
These powers, and the obligations under s 46 discussed above, are all tied to the ‘post-payment review process’. This allows the Agency to correct any payments that it learns were inappropriately paid out and ensures that any misconduct is investigated. In May 2023, the Agency received advice that post-payment debt recovery was not systematically viable, because of the structural problems discussed in the above section. As such, the NDIA moved focus from post to pre-payment reviews in early 2024 as its main mechanism for ensuring compliant claims.⁴
The pre-payment assurance system draws on a different set of powers which were not designed as investigatory tools. Sections 45 and 45A empower the CEO to require relevant information or documents before a claim can be processed. The Agency may cancel, release or hold claims indefinitely. Critically, there is no appeal right for a participant or a provider pursuant to ss45 and 45A.
The Agency has relied on these powers to instigate ‘manual claim reviews’. The Agency only manually reviews some 0.4% of claims before processing, notionally based on five established ‘risk profiles’, e.g. claiming from expired plans, large drawdowns and short-term accommodation claims.⁵
This does not reflect the on-the-ground experience of many NDIS claimants. Intrepidus Law acted for a client who was a provider of psychology services to NDIS participants. The Agency commenced in April 2025 to manually review and impose a “manual lock” on all claims for payment made by our client in relation to agency managed supports, and all claims made by her self-managed and plan-managed patients. This totalled over $600,000 in claims for NDIS services her Psychology clinic delivered. These claims did not tie to any of the five risk profiles. The Agency provided no indication how long this “manual lock” and the “manual claims review” process would last for. The Agency indicated it had received “tips offs” regarding her business and refused to provide any particulars of the allegations made in said “tips offs” nor an opportunity for our client to respond to the veracity of the “tip offs”. It became apparent that the Agency had placed our client’s claims under “manual claim review” indefinitely. This “manual lock” on payments resulted in her clinical practice with over 40 employees going into liquidation. Her patients, mostly vulnerable NDIS participants in receipt of Psychology or complex behavioural supports, abruptly experienced a withdrawal of services from their treating clinicians with whom they had enjoyed years of clinical treatment and history. Our client’s business was effectively starved of cash flow, because of the “manual claims review” and “manual lock” on payments the Agency placed on the claims from the business and its participant clients. There was no formal fraud investigation, no banning orders, no appeal rights.
² National Disability Insurance Scheme Act 2013, pt 3A, div 8; Regulatory Powers Act. ³ Auditor-General Report No. 48, above n 1, [2.62]. ⁴ Ibid [2.62]–[2.66]. ⁵ Ibid [2.68].
Though the NDIA is entitled to verify invoices for potential non-compliance, it cannot simply place claims on indefinite hold without making a prompt decision. Nor should it do so without particularising its substantiated concerns and detailed reasons to such a claimant and affording them the right to reply. Natural justice would have been a mandatory consideration in the Agency’s explicit investigatory powers, if it had instead conducted a fraud investigation. Instead, s45 was used to manually claims, and s45 does not provide any appeal rights, or procedural fairness, as may be expected in a formal fraud response. We are concerned that in using s45 as a quasi-fraud investigation, the Agency is circumventing procedural fairness.
This approach is also alarming from a market-health perspective. Australians would widely protest any other market regulator freezing a small business’s ability to transact in this manner. The loss of goodwill caused by even a few frozen payments is enough to damage business reputation. Further, if anonymous tip-offs can lead to payment freezes, questions ought to be asked about whether the tip-off assessment process affords appropriate procedural fairness protections to the providers or participants who the subject of such tip offs. Where are the rights to reply to anonymous allegations which trigger s45 payment locks which impact lives and reputations with such devastating consequences, such as liquidating a business that took years to build? The agency allows on its website for anyone to make an anonymous tip off against a business or a participant. There is no safeguarding for tip offs which may be malicious, vexatious or false. Indeed, what is there to prevent a business making a vexatious tip off about a competing business, in the hope a resulting manual claim review and payment lock will force it to close down? What safeguards are there to protect victims of vexatious tip offs being made, for example, by a violent spouse wanting to destroy the financial independence of their partner who made own a small NDIS business? This is particularly concerning for NDIS businesses owned by women.
‘Payment locks’ which result from s45 manual claim reviews also pose a risk to participants and the Scheme’s payment integrity. Take for example an actual archetypical ‘dodgy provider’, intentionally defrauding the scheme. If they are successfully identified by the Agency, but a payment freeze is applied, the Agency is only temporarily interrupting the offending. The enterprise is likely to ‘phoenix’ its assets and will only re-emerge trading under a different name unknown to the Agency. Manual reviews do not have a pathway to banning orders or prosecutions against the individuals engaged in misconduct.
Recommendations: address non-compliance drivers by returning to Scheme principles
If we want to take compliance seriously, reform should return to the core principles of the Scheme.
-
Political leaders, policy advisors and media should move away from the ‘rorts’ and ‘fraudsters’ moral panic narrative and focus attention instead on robust scheme design and infrastructure which proactively assists the people using the Scheme to comply with it.
-
Parliament should amend s46 obligations for alignment with the practical structure and use of NDIS plans.
-
The Agency should ensure NDIS plans are built more clearly and consistently, while maintaining choice and control for participants. Every participant should understand precisely
what they can purchase under their plan. Every provider must be able to access current and correct information on what a participant is allowed to purchase with their particular plan, without compromising the privacy and confidentiality of NDIS plans.
-
Parliament must amend s45 manual claims reviews to explicitly embed procedural fairness protections and appeal rights.
-
Parliament and the Agency must ensure safeguarding provisions, a right of reply and a presumption of innocence with respect to public “tip offs” which currently often trigger manual claim reviews on participants and providers, with devastating consequences.
-
The Agency should use its proper investigatory functions when it suspects fraud, not conduct quasi fraud investigations via s45 manual claim reviews. Manual claim reviews should be triggered by anomalies with a specific particular claim, not assumptions about a provider’s or a participant entire bona fides.
Yours faithfully
redacted
Belinda Kochanowska
Principal Solicitor / Founder
Intrepidus Law
Prepared with Trinity Ford Law Clerk Intrepidus Law