Introduction

Our Voice Australia (OVA) welcomes the opportunity to contribute to the Joint Committee of Public Accounts and Audit’s (the Committees) inquiry into the administration of the National Disability Insurance Scheme (NDIS). OVA is a volunteer organisation that advocates with and for supported employees.

OVA’s submission outlines concern with the National Disability Insurance Agency’s (NDIA) management of financial sustainability risks and provider compliance with NDIS claim requirements, as well as the NDIS Quality and Safeguarding Commission’s (NDIS Commission) regulation of the supported employment sector.

When examining these experiences, the Committee’s attention is drawn to commentary and findings in Auditor-General Report No. 48 2024-25 (NDIA’s Management of Claimant Compliance with National Disability Insurance Scheme Claim Requirements) and Auditor-General Report No. 2 2025-26 (Effectiveness of the NDIS Commission’s Regulatory Functions).

Submission summary

The supported employment sector risks being undermined by “sharp” and non-compliant claiming practices that prioritize provider profitability over participant safety and wellbeing. OVA recommends the NDIA introduce clear and specific claim requirements for supported employment services and transition from its passive oversight model to proactive verification of support ratios in group-based settings.

Based on the experience of OVA’s committee and members, there are pockets of providers who systemically manipulate and mismanage ratio-based funding by billing for high levels of support while providing significantly thinner supervision on the ground. These organisations often legitimize poor practices “on paper” by assigning operational staff—such as production or retail managers—to support roles even though their primary duties involve business operations rather than direct disability assistance.

Significant gaps in oversight by the NDIA and the NDIS Commission enable these practices to occur. The NDIA lacks mechanisms to verify if funded ratios are physically provided and relies heavily on provider honesty and reactive “tipoffs”. Although supported employment providers are NDIS registered, quality audits have shown to be ineffective at detecting billing discrepancies, validating paperwork rather than actual practice.

Background

NDIS supports in employment

NDIS employment supports facilitate the economic participation of people with more significant disability, generally surpassing what may be reasonably provided by an employer or through mainstream employment services.

NDIS funding can be used for supports in employment – day-to-day assistance in the workplace to maintain employment that can include:

• on-the-job training and intermittent support with daily work tasks
• direct supervision and/or group-based support to enable meaningful participation at work
• supports to manage disability-related behaviour or complex needs at work
• on-the-job assessments related to the impact of a person’s disability on their ability to work
• job customisation

Supported employment providers

Under the NDIS, supports in employment are typically delivered in group workplaces run by supported employment service providers (previously known as Australian Disability Enterprises or ADEs) and funded through individual participant plans.

145 supported employment providers operate across Australia, providing jobs to over 15,000 scheme participants. All providers of supported employment are NDIS registered, meaning they are subject to ongoing audits by the NDIS Commission and are required to comply with the NDIS Code of Conduct, NDIS Practice Standard and the NDIS Act.

Participants in supported employment

NDIS participants receiving assistance from supported employment service providers are known as supported employees. They typically work in closed, on-site settings and do jobs involving manual labour such as warehousing, packaging and assembly, gardening, hospitality and cleaning.1

Most supported employees have an intellectual disability or cognitive impairment. A significant number live with co-morbidities such as epilepsy, autism, and cerebral palsy, which can result in fluctuating capacity levels and exacerbate challenging behaviours.

Supported employees with more severe disabilities may require personal assistance in the workplace to eat, drink, use the bathroom or take medication. Others may need

1 NDIA, Supported employment survey report, 2024

Overview of non-compliant claiming practices for

group services

Claiming for group-based NDIS services

All group-based NDIS services are funded based on the ratio of support provided to a participant. The amount a provider claims from a participant’s plan is based on the standard hourly price of the service, divided by the number of other participants they share a support worker with2. Put simply: the cost per participant decreases as the group size increases.

Ratio-based funding in supported employment

For supports in employment, the standard support worker’s hourly rate is $70.233.

• At a 1:1 ratio, one worker supports one participant. The cost is the full $70.23 per hour.
• At a 1:3 ratio, one worker supports three participants. Each participant is charged $23.41 per hour.
• At a 1:5 ratio, one support worker supports five participants. Each participant is charged $14.04 per hour.

Inflating support ratios and overcharging for group-based

services

Ratio-based NDIS funding dictates how much a provider can charge based on the number of participants sharing a support worker. Compliance issues arise when a provider bills a participant for a higher ratio of support than supplied, inflating the hourly cost.

The realities, risks and consequences of ratio-based overcharging were examined by the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (Disability Royal Commission) during its forensic examination of registered

2 NDIA, Group-Based Social and Community Participation – Guidance for pricing transition, October 2023

3 National Disability Insurance Scheme, NDIS Pricing Arrangements and Price Limits 2025-26, 24 November 2025 (effective date)

Provider Afford

The day programs operated for people with moderate to severe intellectual disability.

Over several years, Afford’s staffing arrangements and support ratios were systematically mismanaged at the Mount Druitt day program, directly compromising the safety and developmental progress of participants. During this time, families were told their loved ones required one-to-one support but were unable to verify the services being billed and reconcile charges with actual daily activities.

Preventing and Responding to Violence, Abuse, Neglect and Exploitation in Disability Services (Afford Case Study)

The Disability Royal Commission Heard Evidence from Parents of Three Young Men With Disability Who Participated In Mount Druitt Day Program – Jason, Simon And Toby.

Ratios in Practice:

• Each young man had a similar experience regarding support ratios. They all commenced the day program with a 1:3 ratio and later learned they needed 1:1 support. This significantly increased NDIS funding requirements, causing concern among families that costs would exceed existing plan budgets.

Situation:

Despite paying for higher ratios, family members observed declines in communication skills and increases in behaviors of concern while attending the day program. Toby was lost on two occasions due to inadequate supervision during work experiences at shopping centers. However, there was “virtually no way” for families to confirm if high-cost one-on-one support was genuinely provided or whether participants received support within larger group settings without knowledge.

Real-world Impact:

According to witness testimony, participant safety was directly compromised at the day program resulting in developmental stagnation or regression compared to progress made after transitioning into genuine one-to-one support outside Afford’s environment.

Identified gaps in regulatory monitoring and oversight

The evidence and findings of the Disability Royal Commission highlight deficiencies in the financial monitoring and oversight of group services8. While the NDIA employs system controls to prevent over-claiming against a participant’s budget, it lacks mechanisms to verify if the funded ratio was physically provided on the ground. Instead, the NDIA primarily relies on the honesty and integrity of providers and places the onus on participants (and their families) to identify and report potential fraud and non-compliance.

The Disability Royal Commission also identified how regulatory gaps and information silos impeded the NDIS Commission’s ability to identify ratio discrepancies and funding misuse. Firstly, quality audits for registered providers are seen to validate paperwork, not practice; they check if a provider has the required systems in place, but they do not typically verify if the provider is complying with those rules in daily practice. Providers can pass audits by having perfect “on paper” policies while simultaneously engaging in fraudulent activities, such as altering progress notes to overclaim funds from the NDIS (e.g., changing a 1:2 ratio to 1:1).9

Secondly, the NDIS Commission does not routinely or systematically share with quality auditors the information that would signal systemic non-compliance with support ratios (such as a provider’s history of complaints, reportable incidents, or ongoing investigations). Because auditors do not have a “true picture” of a provider’s performance when conducting registration audits, they may fail to sample high-risk sites or services where ratio manipulation is occurring.

8 The NDIA’s regulatory framework for group-based services is built upon a market stewardship model that utilises “indicative support ratios” to calculate participant funding rather than mandating specific ratios for service delivery. Participants have access to flexible funding and are expected to negotiate a mix of support with providers through service agreements. (Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, Statement of Gerrie Mitra, Public Hearing 23 - Preventing and responding to violence, abuse, neglect and exploitation in disability services, 1 April 2022).

9 Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, Exhibit 23-56, ‘Statement of [Erynn]’, 2 May 2022,

5

Non-compliant claiming practices of supported employment service providers

Fraud and overcharging in supported employment

Reflecting the themes of the Afford case study, OVA has seen providers overcharge for staff-to-participant ratios in supported employment services; these practices go under-the-radar due to the NDIA’s weak and passive oversight over group-based services.

Like the participants’ attending the Afford day program, supported employees’ exposure to exploitative practices is compounded by their intellectual disability. They lack the level of reading comprehension needed to review a standard service agreement or interpret an invoice, so are unable to identify billing discrepancies. Instead, they wholly rely on their family members and carers to monitor provider claiming and service delivery (which can prove challenging if the participant works in a “closed” workplace).

Case studies of claimant non-compliance

In simple scenarios seen by OVA, a provider charges for a level of support that cannot feasibly or legitimately be delivered based on the total number of frontline staff rostered on during the participant’s shift.

Ratios in practice:

• In a packaging and sorting facility, sixty participants work across different stages of a production line. The provider claims a ratio of 1:6, indicating each participant shares a support worker with five other people. However, the facility only has three support staff rostered on each shift and assistance is spread thin.

Scenario:

A participant, with known epilepsy, has a seizure while working. However, no support workers are nearby during the incident to administer the seizure management plan and provide first aid as needed. Instead, they are assisting participants at other workstations, unaware of the medical emergency unfolding elsewhere in the warehouse.

Real-world impact:

The participant having the seizure is left alone for twenty minutes, placing them at serious risk of harm and hospitalisation.

OVA has also witnessed providers engage in more complicated ratio manipulation tactics, where participants receiving group services pay for conflicting levels of support. In these scenarios, each participant risks being overcharged and the health, safety and wellbeing of the entire group is jeopardised.

Critical issues around the application of support ratios in ADEs

A single support worker may stand alongside or assist a team of workers; one participant is charged the full individual rate while the others are charged the group rate. In practice, the support worker may only to attend to the needs of the person paying for individual support, oblivious to the discrepancy between how the service is being charged and operated. In other circumstances, the support worker provides care and assistance across the group, ultimately neglecting the participant paying for individual support.

Ratios in practice:

A participant, with significant physical and intellectual disability, swaps to a new provider. They previously paid for supported employment services at a 1:6 ratio. However, the new provider advised the participant (and their family/carer) that they needed all-day individual support (1:1 ratio) to work at the warehouse.

Scenario:

The participant with significant support needs works on a table with five other participants and pays for 1:1 support. One support worker oversees the group, providing light-touch assistance and supervision. They do not actively support the participant with significant disability or act aware of the level of care and assistance they require. The other participants pay for group supports (at a 1:6 ratio).

Real-world impact:

The participant with significant disability requires help and prompting to drink water, pay for lunch and use the bathroom. No formal or individual assistance is provided throughout the day, exposing them to daily harm and neglect.

Sharp and dishonest claiming practices

Critical issues around the application of support ratios in ADEs

From 2020, the NDIA took responsibility for supported employment services, shifting almost all the existing participants onto the NDIS. Prior to the full NDIS roll-out, supported employment service providers were funded directly by the Department of Social Services, operating as Australian Disability Enterprises (ADEs).

When investigating the application of the new NDIS pricing model, Keogh Bay identified a critical grey area in how ADEs applied the new funding ratios in practice; providers charged participants for a full day of assistance, even in circumstances where support staff undertook work themselves while providing overall supervision or ad-hoc help10.

10 The NDIA and DSS contracted Keogh Bay to undertake a project to gain insight on ADE experience and outcomes in the practical application of the new supported employment pricing to be adopted by ADEs commencing 1 July 2020. According to the project overview, the results would inform action from the NDIA to ensure all ADEs transition effectively to the new pricing model under the NDIS.

Delivering and claiming supported employment services in practice:

The supported employment provider handbook provides vague, high-level information on setting and claiming support ratios. Where providers request specific information from the NDIA on pricing rules and compliance, they often receive non-committal responses, typically based on principles rather than practice.

Scenario:

ADEs interpret and apply ratios of support differently, resulting in inconsistent practices in the sector. Some providers deliver supported employment services strongly aligned to the NDIS Code of Conduct and NDIS Practice Standards: safely, ethically, and in the best interests of participants. Other providers charge for supported employment services in sharp, dishonest and potentially non-compliant ways, appearing to favour profitability over mission and purpose.

Organisations can legitimise poor claiming practices “on paper” by giving staff members amorphous or misleading job titles such as production manager, on-site supervisor or employment coach, irrespective of whether they are employed to provide direct on-the-job support to participants. In these scenarios, a provider charges a participant for a high ratio of support but provides minimal day-to-day care, assistance or capacity building.

Real-world impact:

When providers use opaque and dishonest resourcing practices to “meet” support ratios, participants are at risk of harm, neglect and exploitation. Staff are likely to find it challenging, on a day-to-day basis, to fully address the needs of participants or provide a safe environment. The level of care and support becomes compromised, potentially falling short of NDIS practice standards.

Poor and opaque provider practices under the NDIS pricing model

Five years on, delivery and claiming practices for supported employment services are obfuscated under the NDIS pricing model. The practical definition of a “support worker” remains largely open to provider interpretation, with subjective standards for support ratios and how participants’ funding translates into the level of care, assistance and capacity building provided to them.

During this time, OVA has witnessed providers claim for a group supported employment service simply because participants work in the general vicinity of operational staff or other non-disabled employees. These types of “support workers” are principally hired to handle daily business operations, systems, and customers, restricting their capacity to actively supervise the participants they are ostensibly responsible for14.

Ratios in practice:

At a second-hand shop, one retail store manager supervises a group of four to five participants. During peak times, there may be one other non-disabled staff member working, principally employed to assist with day-to-day running of the store. Based on these staffing arrangements, the provider charges each participant for a 1:4 or 1:5 ratio of support.

Situation:

The primary duties of the store manager and other non-disabled staff member revolve around serving customers, stocking clothes, processing donations, and managing the shop floor. Neither has an explicit or primary responsibility to assist participants and both have trouble providing regular disability support around the demands of the零售店。Access to participants’ behaviour support plans, risk assessment and other care information is extremely limited.

Real-world impact:

On a hot summer day (40°C), a participant, with known sensory and behavioural issues, starts overheating on the job. They problem is only identified once they have sweat through all their clothes. The store manager is rostered on by themselves and finds it challenging to re-regulate the participant. The store manager ultimately takes the participant outside the store to cool-down. The participant then runs away and needs to be searched for, leaving everyone else working unsupervised for an extended period.

These sharp practices can be seen when “support workers” or “supervisors” are classified under Grades 2 or 3 of the Supported Employment Services Award (SESA). The classification of these employees suggests they are not principally hired to provide disability care and support (otherwise, they would be paid under the Social, Community, Home Care and Disability Services Award) or to supervise and train others (otherwise they would be classified at Grade 4 or higher under the SESA).

In some circumstances, the participant and their family have agreed for NDIS funding

to go towards specific support staff who actively supervise a small group of workers. However, in practice, the provider has structured the support ratio around staff who may spend most of their time in an office or separate work area, with minimal-to-no line of sight over, or engagement with, participants.

Ratios in practice:

In an industrial warehouse, one production supervisor oversees a group of thirty

participants. In a separate section, there are two non-disabled workers completing higher-order assembly tasks. The non-disabled workers keep to themselves, responsible for the quality and quantity of certain production output. Based on these staffing arrangements, the provider charges each participant for a ratio of 1:10 support.

Scenario:

A participant, with known sensory and behavioural challenges, becomes overstimulated by the work environment and walks off outside. The production supervisor remains within the warehouse to monitor the larger group and manage any health and safety risks. The two non-disabled workers stay on-task and continue undertaking the production duties assigned to them.

Real-world impact:

The participant spends the remaining two hours of their shift alone, pacing between the front of the warehouse and the courtyard. Following the afternoon pick-up period, head office receives a worried phone call from the participant’s gparents; their son never came home from work. The provider had lost him.

A few hours later, the parents receive a call from a police officer who had found their son in the passenger seat of a wanted vehicle. Unsupervised, the participant had been picked up by a stranger (rather than a taxi or rideshare) and was only found because the police had pulled the driver over at a set of traffic lights.

Resolving gaps in NDIA regulation and oversight of

supported employment

Impact of non-compliant claims on NDIS sustainability

Existing NDIA compliance frameworks and processes are not designed to identify or deter non-compliant claiming of supported employment services. Where providers harm, exploit or take advantage of working participants, the NDIA falls short of its statutory function to improve the social and economic participation of people with disability and deliver a financially sustainable NDIS.

The financial cost of ratio-based non-compliance in supported employment can accumulate greatly over time. Most participants remain in supported employment for their entire working life, typically remaining with the same provider15. NDIS funding can be misappropriated, claim-by-claim, over many years.

The cumulative cost of non-compliant ratios of support

A participant pays $632 per fortnight to work three days in supported employment at a 1:5 ratio (based on the provider charging for every hour the participant works). If the actual staff-to-participant numbers are 1:10 or the ratios are resourced disingenuously, around $16,000 of NDIS funding is claimed illegally or dishonestly per year.

Assuming support ratios are systematically mismanaged within an organisation, The annual cost of provider non-compliance would be $1,280,000 for a workforce of eighty part-time participants.

Deterring claimant non-compliance and sharp practices

The NDIA lacks foundational controls to prevent overcharging for supported employment services, especially “clear and specific claim requirements” and “robust systems and processes to verify claims”. As part of the Crack Down on Fraud Program, OVA recommends that the NDIA introduce countermeasures for non- compliant and sharp claiming practices in supported employment.

As outlined earlier, NDIA’s vague and non-prescriptive guidance for claiming supported employment services leads to variable service quality and the potential for poor claiming practices. Support staff roles and ratios are subject to broad interpretation by supported employment providers, exposing participants to the risk of sharp and exploitative practices. More broadly, the regulatory environment enables providers to manipulate support ratios and overcharge participants with minimal fear of detection.

15 Firstly, people with intellectual disability strongly favour consistency and routine, so are often unwilling to alter existing day-to-day activities. Secondly, the current NDIS system makes it challenging for supported employees to “shop around” for higher quality services and scalable pathways into mainstream roles are still a work in progress for government and providers.

Detecting and responding to non-compliant claims in supported

employment

OVA recommends the NDIA take proactive steps to address claim non-compliance through its manual payment reviews process. The ‘risk profiles’ used for the NDIA’s pre-payment reviews do not capture group or ratio-based programs (i.e., supported employment services), perpetuating previously identified flaws in the NDIA’s detection and response controls.

The NDIA’s tip-off mechanism is the only existing avenue for detecting and responding to non-compliant claiming by supported employment providers. Reactive, participant-initiated oversight approaches are fundamentally insufficient at mitigating the risks of ratio-based overcharging – as emphasised throughout our submission, supported employees have a severely limited capacity to raise concerns about provider claiming and service delivery.

In March 2022, Deloitte conducted a review of the NDIA’s fraud and intelligence functions and identified weaknesses in NDIS detection and response controls. Deloitte observed that the “NDIA’s fraud intelligence and investigations prioritised serious and organised fraud over opportunistic fraud and non-compliance” and that “the NDIA made limited use of scalable and repeated treatment options to deter lower sophistication, higher volume fraud activity.”