NDIA Accountability Project

Concerns about son’s NDIS funding and NDIA practices

‹ PrevPage 1 of 20 · Source p. 1Next ›

30 January 2026

Committee Secretary Joint Committee of Public Accounts and Audit PO Box 6021 Parliament House Canberra ACT 2600

Via email: jcpaa@aph.gov.au

Submission to the Joint Committee of Public Accounts and Audit Inquiry into the Administration of the National Disability Insurance Scheme (NDIS)

Attached please find our submission to the above-referenced parliamentary committee.

We offer this with significant reservations about the potential for repercussions to our son’s NDIS funding should the NDIA take issue with the points we are raising. However the matters raised in this submission are of sufficient concern, and we have not seen other submissions making these points, that we feel it is important to share our experience with the committee.

We have reviewed and noted the comments on making a submission to a committee inquiry.

As required, our details are set out in this covering letter, however we have not included them in the submission itself.

Out submission does not need to be treated as a confidential submission. However for the sake of our son’s privacy we request that when this submission is published it is marked as ‘Name withheld.’

Yours sincerely,

                                                                           Cover Letter

Submission to the Joint Committee of Public Accounts and Audit

Inquiry into the Administration of the National Disability Insurance Scheme (NDIS)

30 January 2026

Committee Secretary Joint Committee of Public Accounts and Audit PO Box 6021 Parliament House, Canberra ACT 2600

Via email: jcpaa@aph.gov.au

Introduction

  1. On 27 November 2025, the Joint Committee of Public Accounts and Audit (the Committee) resolved to conduct an inquiry into the administration of the National Disability Insurance Scheme (NDIS). It is clear that a primary focus of the Committee is on the financial sustainability of the NDIS.

  2. The Committee has invited stakeholder views about a range of issues set out in the Terms of Reference. We appreciate the opportunity to provide comments on the administration of the NDIS by the National Disability Insurance Agency (NDIA).

  3. In seeking to address the growing cost of the NDIS, we believe it is also important for the Committee to understand current issues with the culture, values, policies and practices of the NDIA and the adverse impact these have on the delivery of services by the NDIA as well as on its financial sustainability.

  4. In this submission, we outline significant concerns about the effectiveness of the NDIA board, the culture and values of the NDIA, the policies, processes and practices of the NDIA and the capability of the NDIA employees. These concerns are based on our direct experience with the NDIA and indirect experience gained from other NDIS participants.

  5. A recent Royal Commission reviewed the actions of a government department under political pressure to reduce costs that did so by targeting vulnerable people. The Minister described the department’s actions in the ‘robo-debt’ case as “a shocking betrayal and failure of empathy towards vulnerable people who needed support from the government”. These words should sound a warning bell after you have read the information set out in this submission about the NDIA’s policies, processes and practices.

About the Authors

  1. One of us has a human resources background, was an HR Manager with an ASX listed company and led a culture program of an Australian big four bank. This experience includes identifying where operational processes conflict with an organisation’s desired culture and values.

  2. The other has a finance background and has experience as an audit partner with a big four firm, and a divisional CFO of an Australian big four bank. This experience includes reviewing organisations’ financial and operational control environments.

  3. We are also the parents of a child (now an adult) who has a severe disability from birth and is completely dependent on support for all aspects of his life. Based on the severity of his disability, our son exemplifies who the NDIS was created to support. Notwithstanding this, we had to go through a two year battle with the NDIA before they acknowledged the level of support our son requires.

Financial Sustainability

  1. After two years of disputing the matter with the NDIA including nine months where the matter was in front of the Administrative Appeals Tribunal (AAT) (later Administrative Review Tribunal (ART)), the NDIA reversed the position it held throughout that period and agreed to provide funding to support the level of care recommended by health professionals.

  2. This submission is not about our son or our particular circumstances. However it does draw on this direct experience, together with that of other carers of NDIS participants, to highlight matters that the Committee should be aware of in its review of the administration of the NDIS.

Financial Sustainability

  1. The starting point to achieve a financially sustainable NDIS is the underpinning legislation for the NDIS and the NDIA’s internal policy guidelines. These need to clearly outline (i) what level of disability (or functional capacity) a person needs to have to be eligible to be a NDIS participant; and (ii) what specific types of supports will be funded by the NDIA.

  2. By contrast the current legislative framework takes a broad view of disability and support that appears to extend assistance to more participants for a wider range of supports than considered sustainable. In this submission we do not take a position on what should or should not be funded. We acknowledge that these are hard conversations for a community to navigate and are critical to resolve if community support for funding people with disability is to be sustained.

  3. Because the existing legislative framework for the NDIS has not addressed these issues, the NDIA’s current approach to improving the NDIA’s financial sustainability appears to be to engage NDIS participants in a form of ‘lawfare’ in which the NDIA:

  • denies or minimises supports through its internal processes;
  • fails to adequately undertake its review processes;
  • engages well paid lawyers to defend its position when taken to external review;
  • draws out these hearings for as long as possible with spurious claims for additional information, while continuing to deny funding;
  • concedes at the 11th hour to avoid the court publishing a decision which would be publicly available and establish a precedent for other NDIS participants;
  • substantially reverses agreements reached with NDIS participants at ART at a subsequent review; and
  • only extends or increases supports when there is an overwhelming number of publicly available decisions.

  1. Rather than advocating for changes in the scope of the NDIS legislation or improving its processes the NDIA instead appears to be introducing a new assessment tool (the Instrument for the Classification and Assessment of Support Needs (I-CAN) version 6) which will be administered by government bureaucrats rather than trained allied health professionals. 1

  2. Of greater concern, despite having its judgement repeatedly overruled at the ART, recent changes to legislation have surreptitiously curtailed the power of the ART to modify plans or reinstate funding.

  3. As a result of these changes, it appears that the ART will only be able to make an order for the NDIA to complete a replacement ‘support needs assessment’ and will no longer be able to make a

Monitoring, measurement and reporting of NDIA performance

  1. Any assessment of the NDIA’s performance needs to start with an assessment of whether the NDIA is meeting the objective set out in its founding legislation and delivering its mission and purpose through its values.

  2. The National Disability Insurance Scheme Act 2013 (NDIS Act) is designated as beneficial legislation because its core objective is to confer social and economic benefits upon a specific group—people with significant and permanent disability—rather than merely regulating behaviour or imposing penalties. This characterisation means that when ambiguities exist within the NDIS Act, they should generally be interpreted in a manner most favorable to the intended beneficiaries.

  3. Based on our direct experience dealing with the NDIA, its policies, processes and practices in many cases seem to be antithetical to the values it espouses.

  4. When it ignores health professionals’ recommendations and substitutes the judgement of NDIA employees with no health training to deny funding, it is not ‘working together to deliver quality outcomes’.

  5. When, despite having reached an agreement at ART, the NDIA subsequently cuts NDIS participants’ funding it aims lower not higher.

  6. When the NDIA’s decisions are repeatedly overturned by the ART, and the NDIA makes no changes to its policies and processes, it is clear that the NDIA does not have ‘the courage to do better’.

  7. When the NDIA’s response to its decisions being repeatedly overturned by the ART, is to remove participants ability to appeal to the ART, it is clear that the NDIA has neither ‘the courage to do better’ or to do ‘the right thing’.

  8. When it makes a mistake, and then both fails to acknowledge it, and when it is pointed out to it, doubles down on the mistake through two re-assessments and review, it neither ‘owns what it do es’ nor ‘does the right thing’.

  9. Our direct experience has revealed a large number of issues with the performance of the NDIA, The policies, processes and practices of the NDIA, the culture and values of the NDIA and the capability of NDIA employees and management.

  10. The issues we highlight below are a fundamental impediment to the NDIA achieving its mission and purpose.

Culture and values of the NDIA

Moral Courage

  1. For an organisation to live its culture and values it needs to have ‘moral courage’. Dr Matt Beard from the Centre for Ethical Leadership has written$ that ‘Moral courage enables a person to do what they know is right, despite the risks, difficulty and potential personal costs. It’s the difference between knowing what needs to be done and actually seeing it through.’ A ‘lack of courage leads to hypocrisy, which leads to breakdowns of trust’.

  2. Dr Beard cautions that ‘Most people assume they … have the moral courage to do what’s right when the situation demands it. Unfortunately, the best evidence tells us many are wrong.’ Evidence that people have moral courage comes from ‘the culture and activities of the company’.

  3. Based on our experience over the last two years only one of the NDIA employees and NDIA funded lawyers with whom we interacted demonstrated moral courage.

  4. An organisation with a culture where employees must repeatedly demonstrate moral courage to fulfil their basic job duties can expect to experience high employee turnover. This could go far in explaining why the NDIA has so many inexperienced new staff who seem incapable of, or uncertain how to, perform their duties.

  5. Dr Beard sets out ‘the ultimate test of moral courage for leaders’: ‘If your actions will require someone else to exercise more courage than you, it’s probably a sign you should be acting differently.’ $

Funding decisions should not depend on strength of advocacy

  1. The level of support and funding provided for a NDIS participant should never depend on the advocacy skills of their carers. However the fact that it does has been a long standing shortcoming in disability support funding.

  2. Through our professions and corporate careers, we have experience dealing with financial matters, disputes and bureaucratic organisations. However we are aware that the carers of other NDIS participants lack this experience. For them the funding required to provide an appropriate level of support is very significant. They are highly dependent on the NDIA’s approval of their funding request.

  3. The use of Functional Capacity Assessments (FCAs) by qualified, third party, health professionals was intended to address these risks. But this safe-guard breaks down when NDIA employees – seemingly without relevant medical or health knowledge and experience – arbitrarily decide to ignore or reject the conclusions set out in FCAs, or embark on ‘opinion shopping’ by repeated requests for updated FCAs. The NDIA, intentionally or inadvertently, has now created a system where families need to advocate that the FCA reports required by and provided to the NDIA are then respected by the NDIA.

  4. If the NDIA has doubts about the qualifications of the experts completing these assessments, that should be addressed through establishing approved panels for particular assessments such as a Home and Living FCA. The corollary of this is that the opinion of a FCA from a health professional who is on the approved panel should be accepted.

  5. There have been a number of cases similar to ours where families have struggled to get the NDIA to fund appropriate supports for their NDIS participant. The NDIA has rejected funding requests on the generic basis that the information provided is inadequate, or that the format of the information provided differed from that which the NDIA was wanting. Despite the NDIA failing to clearly articulate what its information requirements actually are, it rejects, delays or withholds

Concerning Parallels with the Financial Services Royal Commission

  1. These requests also divert financial resources from direct support for an NDIS participant into unnecessary administrative activities, and ultimately increase the cost of the NDIS to tax-payers.

Concerning Parallels with the Financial Services Royal Commission

  1. The types of unethical behaviour outlined in this submission have been seen before in other insurance companies. In 2019 the Financial Services Royal Commission reiterated that insurance companies have a duty to act in utmost good faith.5 The Commission noted that this ’duty of utmost good faith may require an insurer to act, consistently with commercial standards of decency and fairness, with due regard to the interests of the insured.’6

  2. The Royal Commission found that the behaviour of certain insurance companies, including the behaviour of one company which adopted an ‘approach of seeking to avoid the claim, rather than to support the insured’ meant that those insurance companies ’may have breached their duty of utmost good faith … and therefore engaged in misconduct.’7

  3. The Royal Commission further noted that:

     'There can be no basis in principle or in practice to say that obliging an insurer to handle claims efficiently, honestly and fairly is to impose on the individual insurer, or the industry more generally, a burden it should not bear. … The argument can be made only if claims handling is not now conducted efficiently, honestly and fairly.'8

  4. The Royal Commission also noted that “the primary responsibility for misconduct in the financial services industry lies with the entities concerned and those who managed and controlled those entities: their boards and senior management.“9

  5. The Royal Commission referred to ASIC the conduct of certain insurance companies, so ASIC could consider what action it can and should take where companies appeared to have failed to meet their duty of utmost good faith.10

  6. It is disappointing that an organisation so recently formed as the NDIA seems to have so quickly adopted the same unethical behaviours that have been called out so many times about the insurance industry.

Concerning Parallels with the Royal Commission into the Robodebt Scheme

  1. The actions of the NDIA also have a number of concerning parallels with the behaviours of the government department that was the subject of the Royal Commission into the Robodebt Scheme (the Department of Human Services (DHS) now Services Australia). The NDIA, like the DHS, is responsible for providing services to vulnerable people and is under public and political pressure to reduce their costs.

  2. The Royal Commission stressed the ‘importance of public service officers’ acting with integrity.’11 Based on our experience NDIA employees have failed to act with integrity by:

    46.1. failing to ensure assumptions used to determine the level of support provided by the NDIS were accurate or still current;

46. Failing to ensure adequate understanding

46.2.

failing to ensure they had adequate understanding of the medical and therapy assessments set out in the FCA when determining the level of support to be funded by the NDIS;

46.3.

failing to provide adequate reasons for rejecting the assessment of the health expert who had determined the level of support required;

46.4.

failing to check the accuracy of calculations used to determine the amount of funding which was provided to pay for the level of support determined by the NDIA;

46.5.

repeatedly failing to adequately review the NDIS participant plans which resulted in obvious errors being perpetuated.

47. The Royal Commission also noted ‘how little thought’

The Royal Commission also noted ‘how little thought’ was given to how the DHS’s actions ‘would affect welfare recipients’.12 Based on our experience it would appear that the NDIA has this same issue. Throughout our experience we have seen little evidence that the NDIA, its employees or its external lawyers are committed to meeting the five principles set out in the NDIA’s Participant Service Charter.13

48. The Royal Commission further commented on ‘the lengths’

The Royal Commission further commented on ‘the lengths to which public servants were prepared to go to oblige ministers on a quest for savings’.14 Based on our experience with the NDIA this would appear to be a matter which warrants further investigation by the NDIA Board as well as by the Auditor-General and the Minister.

49. The Royal Commission commented:

‘The Robodebt scheme exemplifies an approach which regards those in receipt of social security benefits as a drag on the national economy, an entry on the debit side of the Budget to be reduced by any means available: by casting recipients as a burden on the taxpayer, by making onerous requirements of those who are claiming or have claimed benefit, by minimising the availability of assistance from departmental staff, by clawing back benefits whether justly or not, and by generally making the condition of the social security recipient unpleasant and undesirable.’

50. The Royal Commission also made the following observations:

“The environment in which the development of what would become the Scheme occurred was fraught. It was characterised by a powerful drive for savings, strongly expressed ministerial policy positions, cultural conflicts on an inter- and intra-departmental level and intense pressure experienced by public servants, including those in positions of seniority.” (p28)

“An enthusiasm for savings would seem an anathema to the underlying policy and rationale for social security spending, of supporting those in need.” (p28)

“The commission noted the political policy priorities which created the climate in which the essential features of the Robodebt scheme were conceived by employees of the Department of Human Services (DHS) (p xxiii)

“members of the senior executive of both DSS and DHS were aware of [the Minister’s] policy direction, and the drive for savings. In this context, a pervasive sense of pressure filtered down the management hierarchy.” (p28)

51.

Based on our experience of dealing with the NDIA, and comments by NDIS participants and their carers, there would appear to be a risk that the politicisation of the NDIA’s total expenditure and the media profile around the NDIA in the last 12 to 24 months have resulted in a culture in the NDIA which bears similarities to that of the culture in the DHS that gave rise to the issues with the Robodebt scheme.

  1. The Royal Commission was ‘disheartened’ by ‘the ineffectiveness of … institutional checks and balances … including the Administrative Appeals Tribunal.’ Based on our experience it would appear that there are significant failures in the NDIA’s institutional checks and balances.

  2. The Royal Commission recommended that Services Australia ‘design its policies and processes with a primary emphasis on the recipients it is meant to serve’ (Recommendation 10.1). Based on our experience, many of the NDIA’s practices and processes currently do not have a primary emphasis on the recipients it is meant to serve.

  3. The Royal Commission recommended that Services Australia ‘engage with a recipient prior to the removal of a vulnerability indicator from their file’ (Recommendation 11.3). Based on our experience, and the anecdotal experience of other NDIS participants and their carers, currently the NDIA regularly (i) reduces funding, (ii) constrains funding, or (iii) states that it will reduce funding if an updated health practitioners’ report is not provided, when an updated report should either be unnecessary, because the NDIS participant has a life-long disability, or cannot be assessed, written and submitted because the timeframes for response provided by the NDIA are completely inadequate.

  4. The Royal Commission recommended that DSS should provide training for the lawyers it used including specifically ‘an emphasis on the duty to avoid any compromise to their integrity and professional independence and the challenges that may be presented to a government lawyer in fulfilling that obligation’ (Recommendation 19.4). Based on our experience, it is not clear how the lawyers engaged in our matter met their ‘duty to avoid any compromise to their integrity and professional independence’ when they repeated false or misleading statements made by the NDIA in rejecting funding, despite the detailed information we had provided to the NDIA and its lawyers which highlighted the errors in the information on which the NDIA relied or appeared to rely to support its rejection of the requested funding.

  5. The Royal Commission recommended that ‘Services Australia should put in place a system for identifying AAT cases which raise significant legal and policy issues and ensuring that they are brought to the attention of senior DSS and Services Australia officers’ (Recommendation 20.1). Based on our experience, the NDIA Board ought to have serious concerns about:

  • the total number of cases from NDIS participants that are with the AAT;
  • the growth in the number of these cases ; and
  • the high proportion of applications–74% in FY25 and 75% in FY24 –in relation to which the decision about a plan under review was changed in favour of the NDIS participant and against the position adopted by the NDIA.
  1. The fact that in almost three quarters of cases the ART (formerly the AAT) has rejected the position adopted by the NDIA and decided in favour of the NDIS participant could indicate that either the NDIA lacks the relevant assessment skills to perform a critical element of its role or the NDIA is knowingly allowing cases to escalate to the AAT/ART as part of a deliberate policy and practice of denying claims in order to extend the time period in which lower amounts are paid to an NDIS participant and to enable it to achieve a target of reducing the growth in the total expenditure of the NDIA. Such practices, if they have occurred, would prima facie appear to constitute ‘unconscionable conduct’ and could potentially represent a breach of the NDIA’s duty of utmost good faith.

Policies, processes and practices of the NDIA

Plan preparation

  1. The NDIA has repeatedly issued plans which were replete with errors and omissions. These errors:

  • demonstrate a fundamental failure to understand the consequences of the health conditions of NDIS participants;

  • demonstrate an unwillingness to accept the advice of health experts who do understand the consequences of the health conditions of NDIS participants;

  • undermined or were inconsistent with the stated logic of the NDIA’s decisions;

  • demonstrate a fundamental failure of internal processes to prepare accurate plans; and

  • result in significant inefficiencies and high levels of rework by employees of the NDIA.

  1. In many cases the NDIA’s decision letters which purported to put forward the rationale for rejecting funding were unclear and unintelligible. The ‘word soup’, terminology and phraseology used in these letters create the appearance that the decision letters had been written by a bad AI program.

Lack of basis for rejecting or amending claims

  1. Where a NDIS participant has requested a review of a plan (as a result of a Section 100 Request for a Review or a Change of Circumstance request) the NDIA is required to respond setting out reasons for their decision.

  2. In one instance, in its response to a plan review request the NDIA repeatedly responded with statements that were factually inaccurate, assertions which were not supported by evidence, or statements which were generic.

  3. In this example the NDIA had proposed to fund a mere 14% of the level of Assistance with Daily Living (ADL) support recommended in the FCA. Despite this, in responding to the plan review request the NDIA claimed that this significantly lower level of funding was ‘considered a comparable support to what has been requested’. This assertion was patently not factual, was made without any supporting evidence, and was in direct contradiction with the evidence provided by health professionals.

  4. On two occasions the NDIA planner and their reviewer – a total of four NDIA employees – sought to argue that funding support workers for ADL was not “effective and beneficial” and that it was not “value for money” despite the fact the NDIS participant would be unable to perform any basic functions including moving, toileting, washing, and feeding and would ultimately die without the supports set out in the FCA.

  5. These actions were repeated and / or reviewed and approved by a large number of NDIA employees over a 22 month period.

Errors in plans

  1. Based on our direct experience, the quality of plan reassessments and internal review decisions was low. Blatant errors were repeated in plan reassessments - e.g. dollar values of ADL support were repeated even though the number of funded hours had changed; references to informal supports were repeated even though the NDIA had been informed that this information was two years out of date. Of greater concern, these errors were also repeated in the section 100 review decision even though the errors had been clearly communicated to the NDIA and the existence of these errors was the very basis for the request for a section 100 review.

  2. The NDIA claimed that these fundamental errors were merely ‘the result of human error.’ This response is disingenuous and implausible. The error was not made just once: it was made by the NDIA employees preparing and reviewing three plans. It was repeated by the NDIA employees who conducted the section 100 review and prepared the NDIA decision letter, despite the NDIA

Inability to provide supporting documentation for calculations

  1. Repeatedly plans proposed by the NDIA failed to show how the specific value of funding for an item was calculated. For example, the calculation of the funded value of ADL support should be straight-forward:

    total funding amount = number of hours funded * rate per hour * support-ratio

  2. Despite this the NDIA claimed that ‘the Agency is unable to provide a breakdown of how the specific funding amount was determined.’ This is a concerning statement: the inability of the NDIA to provide supporting documentation showing how a significant amount of funding has been determined is a fundamental failure in the NDIA’s internal control processes.

Apparent use of false precision

  1. Notwithstanding that the NDIA was unable to provide a breakdown of how certain funding amounts were determined, plans proposed by the NDIA repeatedly presented the value of the proposed funding as a very precise number – down to the cent.

  2. The presentation of very precise numerical information in a manner that implies better precision than is justified is referred to as false precision (also referred to as fake precision and spurious precision). False precision is used to convey the impression that simply because a statement is precise it is accurate or true. Done deliberately this could constitute misleading or deceptive conduct.

  3. It is notable that even though subsequently there was a change in the number of hours that the NDIA proposed to fund, the dollar value of funding assessed by the NDIA, down to the cent, was unchanged. This only adds further doubt as to the veracity of the amounts proposed or the NDIA’s calculations. This would appear to represent a fundamental failure in the NDIA’s internal control processes.

Use of rate per hour significantly below the NDIS Price Guide

  1. Repeatedly plans proposed by the NDIA misleadingly claimed to fund a certain number of hours of ADL support for a given dollar value of funding. However the implied average rate per hour used by the NDIA was significantly below any of the rates set out in the NDIS Price Guide.

  2. Given the material difference in the rate per hour used by the NDIA and the rate per hour in the NDIS price guide, and the fact that this error was repeated in three plans that had been subject to review, it would appear that:

    75.1. The NDIA’s employees preparing plans lack the skills, knowledge and capability to make accurate mathematical calculations; and / or

    75.2. The NDIA’s employees reviewing plans lack the skills, knowledge and capability to identify obvious errors; and / or

    75.3. The NDIA is deliberately and deceptively using rates per hour which are significantly below the rates set out in the NDIS Price Guide to make misleading comments about the number of hours of support it is funding and reduce the level of funding provided to participants as part of its efforts to reduce its costs.

Arbitrary removal of funding for repair of critical items

  1. When updating a plan the NDIA arbitrarily removed funding for major and minor repairs to mobility assistive technology. When challenged the NDIA claimed that ‘The Agency has not removed funding for repairs but has removed the specific reference to it in your plan.’ This appears to be Orwellian double-speak: the NDIA position appears to be that even though there is no specific reference to an item in a plan and there is no dollar amount of funding allocated to an item, funding for the item has not actually ‘been removed’ by the NDIA.

  2. A further implication from the NDIA’s statement is that the NDIA believe that a NDIS participant ought to be aware that funding for items for which there is no reference in a plan does in fact exist (on the basis that the NDIA claim it has not been removed), and seemingly, that a NDIS participant should be able to confidently spend against this invisible line item and confidently claim the expense against their plan. This position is nothing short of ludicrous.

  3. Such actions by the NDIA would appear to constitute unconscionable conduct and represent a fundamental failure in the NDIA’s internal control processes.

Delays in funding based on spurious claims of gaps in evidence

  1. During the AAT directions hearing the NDIA requested an ‘independent medical expert assessment.’ While on the face of it this is not unreasonable, the NDIA already had two reports from qualified experts but had chosen to disregard the clear articulation of the NDIS participant’s requirements and the supporting rationale.

  2. It would appear that in this case either the NDIA failed to review the information that had been provided to it, or it deliberately engaged in spurious claims of gaps in evidence to deny funding to a NDIS participant.

  3. The NDIA denied funding for the level of support assessed by a health professional on the basis that it needed to determine ‘how long this support is expected to be ongoing (even if indefinitely)’. This occurred despite the fact that the documentation that had been provided to the NDIA made it quite clear that the NDIS participant had a permanent, severe disability. This could arise for one of two reasons: The NDIA employee undertaking the review, and all of the reviewers, may be incompetent and not understand that a permanent disability is life-long. Alternatively it could imply that, with its focus on cost minimisation, the NDIA was deliberately proposing to fund only a portion of the reasonable and necessary support required by a NDIS participant with a permanent disability because of the higher cost that that would result.

  4. Based on these experiences it would appear that the NDIA’s practices include the arbitrary disregard of the opinions of medical or health professionals’ which it does not like and repeated requests for medical opinions – opinion shopping – until it receives an opinion it does like as a deliberate action to deny funding to NDIS participants.

  5. These types of behaviours by insurance companies were noted in the Royal Commission into financial services and would appear to constitute unconscionable conduct.

Contrived reasons for delay in assessment process

  1. In another instance the NDIA rejected a section 100 review request on the basis that the NDIA “did not have enough information to identify which NDIS participant your enquiry relates to” and

Lack of specific guidance on what additional information required

  1. All of the information requested by the NDIA was included in an attachment to the email the NDIA had received. The NDIA employee failed to read the information provided with the email requesting the section 100 review, and then used this as an excuse to reset the timeline for the NDIA to respond to this request.

  2. The inability of NDIA employees to understand that emails can include attachments, and/or their inability to open an email attachment wastes tax payer resources and NDIS participants’ time and adds to the delay in getting matters resolved. Techniques such as this, if done deliberately to meet response time targets, do not reflect well on the practices or culture of the NDIA and would appear to constitute unconscionable conduct.

Lack of specific guidance on what additional information required

  1. The NDIA appears to have a practice of rejecting funding on the basis that ‘additional information is required’. For example, in one of its decision letters the NDIA wrote “I have been unable to determine if other alternative options have been explored…”.

  2. However, although this was put forward as the reason the funding request was rejected, the NDIA did not provide any specific information on what information or evidence it believed was lacking, and would be required for the funding request to be approved, and failed to request any additional information. Instead the NDIA’s inability to reach a conclusion was used to deny funding.

  3. As a result of this lack of transparency, NDIS participants are left guessing what information the NDIA is seeking. This can (and has) resulted in NDIS participants wasting NDIA funding to commission additional reports – which based on our experience, are unlikely to actually be read by the NDIA – in the hope, often vain, that the additional report will contain the (unknown) information that the NDIA claims was lacking, the absence of which provided the rationale for the NDIA to reject the funding request.

  4. These requests by the NDIA also divert financial resources from direct support for an NDIS participant into unnecessary administrative activities, and ultimately increase the cost of the NDIS to tax-payers.

  5. The ART /AAT has consistently indicated that the NDIS is beneficial legislation and therefore the NDIA is expected to seek clarification rather than automatically refuse funding.

NDIA plan review and oversight process

  1. While periodic plan reviews are important, the NDIA appears to lack a structured process for this. Based on our experience, and that of other carers of NDIS participants, the NDIA’s timing of plan reviews can be erratic and unpredictable.

  2. In some cases supports which have been deemed ’reasonable and necessary’19 in one planning cycle are not upheld and maintained in a subsequent planning cycle. Instead, NDIS participants report arbitrary unexplained cuts to plans when there has been no reported change of circumstances. This should simply not be possible.

  3. In other cases, the NDIA has arranged a ‘catch up’ phone call, or even called without notice, has not communicated that the purpose of the NDIA’s call is to undertake a plan review, but has then subsequently modified an NDIS participant’s plan based on the information gleaned from the call. In some cases the NDIA has initiated a plan review only shortly after a plan has been created.

Lack Of Internal Controls And Communication Failures

Each of The Plans Containing Errors Noted Above Was Subject To A Review

Each of the plans containing the errors noted above was subject to a review. These errors should have been identified by a proper managerial review against the Change of Circumstances or the section 100 internal review request. For such errors to be occurring on so many plans which are subsequently overturned at an ART review reflects a fundamental failure of basic internal controls at the NDIA. The Board should expect to be made aware of such failures through a robust internal audit process.

Lack Of Timely Or Effective Communication

There are significant discrepancies in the NDIA’s approach to communication. In one instance funding was denied based on a letter that the NDIA claimed to have sent but which was not received by the NDIS participant by email or by post, and was not referred to by an NDIA employee in a subsequent phone call about the plan. The existence of this alleged letter only came to light when it was included in the T-Docs provided by the NDIA in response to an appeal to the AAT.

In another case, a revised plan was loaded by the NDIA into the NDIS portal, but this was not communicated to the NDIS participant. As a result, the NDIS participant would not be aware that they were able to access a higher level of funding.

In many cases the NDIA’s decision letters which purport to put forward the rationale for rejecting funding were unclear and intelligible. The ‘word soup’ and terminology and phraseology used in these letters created the appearance that the decision letters had been written by a bad AI program.

Given the NDIA’s ineffective communication practices, and the failure of the NDIA to respond within its legislated response time it would appear that either:

  • 101.1. The NDIA lacks the capability and/or resources to discharge its statutory obligations; and/or
  • 101.2. The NDIA, as part of its efforts to reduce its expenses, has adopted a policy of (i) deliberately delaying decisions, and denying funding to NDIS participants as a result; and (ii) deliberately not communicating to NDIS participants when funding has been approved to reduce the participant’s utilisation of that funding.

Apparent Deliberate Use Of AAT To Delay Funding Claims

In the last two years, for a staggering three quarters of NDIA cases (73% in FY25 and 74% in FY24), that went to the AAT (or its replacement, the ART) was the decision under review was changed by the AAT/ART in favour of the NDIS participant and against the position adopted by the NDIA.

It seems that there are only two conclusions that could be drawn from this:

  • 103.1. The NDIA’s employees lack the skills, knowledge and capability to make an accurate assessment of the level of support required by a NDIS participant; and / or
  • 103.2. The NDIA is deliberately approving lower levels of support for participants, and the resultant funding provided, as part of its efforts to reduce its costs.

In its Quarterly Report, the NDIA states that in the March 2025 quarter ‘approximately 69% [of cases that had gone to the ART] were resolved by agreement…’. While this statement is factually correct, it is fundamentally misleading.

In our circumstance the so-called ‘agreement’ was reached only after the NDIA had disputed the matter for almost two years, denied funding throughout this period, and refused our request to provide a detailed explanation of the cause of the many failings in the NDIA’s processes throughout this period. There has been no explanation as to why the two reviews within the NDIA

Inappropriate Approach to AAT Review

106.

Queensland Advocacy for Inclusion (QAI) is an advocacy organisation for people with a disability. QAI was commissioned by the Queensland Department of Seniors, Disability Services and Aboriginal and Torres Strait Islander Partnerships to undertake an analysis of National Disability Insurance Scheme (NDIS) plan reviews to identify trends and potential lessons for advocacy practitioners.21

107.

QAI found that only one per cent of matters taken to AAT result in a published decision. As QAI have noted ’This means a large majority of decision-making and outcomes at the AAT are opaque and shrouded in secrecy.’22 It is also notable that while the NDIA appears to use the ART to delay funding, it appears to deliberately avoid having the ART adjudicate on a matter to avoid setting a precedent, even if only informally, which could arise if the ART’s decision was published and available to other NDIS participants.

Inappropriate approach to AAT review

108.

Where the NDIA’s decisions are challenged at AAT/ART, the result usually is that NDIS participants without legal representation are opposed by tax-payer funded lawyers acting for the NDIA while the NDIA employees who have made the decision being challenged are either not present at the hearing or remain silent and are unwilling to support their decision.

109.

The report from QAI states: ‘The NDIA is always represented by a lawyer (who is either employed by the NDIA, the Australian Government Solicitors or an external law firm).’ By contrast only 13% of applicants had legal representation. 23

110.

Based on our personal experience, the conduct at the NDIA and of its lawyers could fail to meet the Australian Public Sector Code of Conduct and the Model Litigant obligations.

111.

The NDIA received a FCA but failed to act upon the recommendations in that FCA as part of a plan reassessment. This was repeated when the NDIA responded to our request for a section 100 review. Despite having received a FCA, when the case came to the AAT, the NDIA requested another FCA without any commentary on what information gaps existed within the existing FCA. It was only through intervention by the AAT member that required the NDIA to specify what information gaps it believed existed in the original FCA. After yet another delay, the NDIA responded with a series of trivial questions including some which were not relevant to the FCA at all. Throughout this process the NDIA’s lawyer evidently failed to challenge the conduct of the NDIA’s employees.

112.

Our experience with the NDIA at the AAT appears to be the norm rather than an exception. In HRZI v NDIA [2023] AATA 48124 Member Webb noted: ‘Under S33(1A) of the AAT Act, the NDIA is required to assist the Tribunal to make the correct or preferable decision in the proceedings and under S33(1AB), both parties are required to assist the Tribunal to fulfill the objective in s2A of that Act.’ The Member went on to criticize the approach taken by the NDIA noting that

NDIA plan review following ART/AAT decisions

Of more concern, are reports of the NDIA undertaking plan reviews which overturn outcomes decided in an AAT hearing.

In one example reported in the press (McGarrigles v NDIA 25), the funding of a NDIS participant who had taken the NDIA to federal court was subsequently reduced significantly by the NDIA,

including a 70% reduction of the funding item that had been the subject of the earlier court case, with ‘no clear indication’ of which supports were reduced and the basis for the reduction. What was particularly disappointing about this case was that the NDIA chose to spend funds on lawyers to fight this matter in the ART, to then appeal the matter to the federal court and when that failed, to appeal the matter to the full bench of the federal court. The full bench of the federal court dismissed the NDIA’s application for appeal.

It was reported that the NDIA subsequently sought to explain this away as a ‘system error’. This explanation seems implausible given similar seemingly unethical behaviour has been reported by other NDIA participants.

Capability of NDIA employees

The experiences we have described in this submission highlight fundamental failures in the competence, culture and values of the NDIA.

Because of our direct experience with the NDIA, and our indirect experience gained from other NDIS participants and their parents and carers, we believe that there are serious issues with the integrity and values of the NDIA the accuracy and effectiveness of its processes or the competence of its employees.

Employees of the NDIA without health qualifications are making uninformed and unsupported decisions about the level of care required by NDIS participants. At times these decisions are being made despite clearly documented and supported evidence that has been provided by health professionals. As another submission to the Committee has noted ‘This is comparable to allowing individuals with no medical training to prescribe treatment.’

The consequences of this are often significant for NDIS participants. In a recent instance funding for the required support for a NDIS participant that had been outlined by a health professional was denied by the NDIA. It has been reported that one evening that NDIS participant died as a result of the absence of the support required.26

It is hard to escape the conclusion that a contributing factor, and possibly the primary factor,

which has resulted in these failures is the culture in the NDIA which prioritises a focus on reducing the cost of the NDIS.

Effectiveness of the NDIA board

Because the failures we have noted in this submission are consistent with the experience of so many other NDIS participants it appears that either (i) there has been a breakdown of processes and controls at the NDIA or (ii) these practices are sanctioned directly or indirectly by NDIA management and/or the Board of Directors of the NDIA.

In either of these circumstances the NDIA’s management and/or the Board of Directors would be failing in their function to ‘ensure the proper, efficient and effective performance of the Agency’s functions’ where the NDIA’s main statutory function is ’delivering the National Disability Insurance Scheme (NDIS) so as to, amongst other things, support the independence, and social and economic

Audit of the NDIA

  1. The specific Auditor-General reports noted in the Terms of Reference do not appear to have covered any of the NDIA’s processes, policies and practices referred to in this submission.

  2. A report by the Auditor-General which was not noted in the Terms of Reference’s was on the Effectiveness of the National Disability Insurance Agency’s Management of Assistance with Daily Life Supports dated 28 June 2023 (the 2023 report). An objective of this report was to ‘assess the effectiveness of the NDIA’s management of assistance with daily life supports’ and specifically to assess ‘Does the NDIA effectively support NDIS participants who require assistance with daily life?’ However it does not appear that any of the types of failures of the NDIA’s policies, processes and practices identified in this submission were identified in the Auditor-General’s 2023 audit and report.

  3. The clear emphasis in the Auditor-General’s audit procedures and reports is on testing for overstatement of the NDIA’s expenses. None of the recommendations in the Auditor-General’s reports that we have reviewed have adequately addressed the risk that funding for NDIS participants by the NDIA is understated, whether deliberately or inadvertently, as a result of failures in the NDIA’s policies, processes and practices. This appears to be a significant blind spot in the Auditor-General’s planning, risk assessment, audit procedures and reporting.

  4. The Auditor-General’s review of the Effectiveness of the Board of the NDIA dated 10 June 2025 noted that:

    'Performance measurement involves collecting, analysing and reporting information about the performance of an entity against its purposes. Having effective performance reporting and monitoring arrangements is an integral feature of good corporate governance.'

  5. The Auditor-General concluded that ‘Corporate plans largely complied with PGPA Rule requirements, and the Board approved the performance measures in corporate plans prior to their publication’. This conclusion appears to be inconsistent with the matters noted in this submission. This suggests that there were gaps in the audit processes undertaken by the Auditor-General.

Page 17

130.

The significant proportion of NDIA decisions overturned by the AAT/ART should have raised a concern with the Auditor-General on the adequacy of the NDIA’s internal control processes. However the ANAO report on the effectiveness of the board does not include any references to the NDIA Board’s response to the fact that the NDIA’s decisions were repeatedly overturned by the AAT/ART.

131.

The Auditor-General’s 2023 report states that it did consider Administrative Appeal Tribunal decisions. In FY22 there were 5918 cases related to the NDIA lodged with the AAT and 3348 cases were finalised of which more than half – 58% – resulted in the determination of the NDIA being changed by the AAT. 31 Despite this, and somewhat incongruously, the Auditor-General’s report concluded:

‘ANAO analysis of Administrative Appeals Tribunal decisions published in 2021–22 did not identify\n \nany systemic issues with NDIA policies, procedures or guidelines related to ADL.’

132.

It is not clear what evidence the ANAO considered in reaching this conclusion in its report. The fact that the AAT overturned 58% of the NDIA’s decisions in FY22 would, prima facie, appear to be evidence that there were in fact ‘issues with NDIA policies, procedures or guidelines…’ and the Auditor-General should have performed additional audit procedures in relation to this matter.

133.

Since the publication of AAT decisions in FY22 in 2023 there has been a significant increases in:

  • 133.1. The total number of cases from NDIS participants with the AAT/ART; and

  • 133.2. the proportion of cases for which the decision about a plan under review was changed in favour of the NDIS participant and against the position adopted by the NDIA – 74% in FY25 and 75% in FY24.33

134.

It is not clear from the Auditor-General’s reports reviewed that the ANAO has subsequently: (i) undertaken any ‘analysis of Administrative Appeal Tribunal decisions’; (ii) queried with the NDIA’s Board and management the significant increase in the number of cases with the AAT/ART and the fact that the vast majority of the NDIA’s decisions were overturned by the AAT/ART; (iii) considered the risk of systemic issues with NDIA policies, procedures or guidelines; or (iv) expanded its audit testing procedures to consider the risk of understatement of the NDIA’s expenditure to NDIS participants.

135.

Two of the findings from work undertaken by QAI on AAT decisions are:

  • 135.1. There has been an increase in the percentage of internal review outcomes in which the NDIA reviewer has affirmed the NDIA’s original decision.\n
  • 135.2. That the increase in applications to the AAT for a review of a NDIA decision has occurred without a commensurate increase in applications by NDIS participants for an internal review by the NDIA of its decision (a section 100 Review).

136.

QAI concludes that this ‘demonstrates that the key driving factor in the increasing number of people applying to the AAT appears to be a consequence of a change in approach by the NDIA at the internal review stage.’ The Auditor-General does not appear to have considered this in the planning, risk assessment and audit testing of the NDIA.

137.

When referring to AAT cases involving Services Australia the Robodebt Royal Commission recommended that ‘Services Australia should put in place a system for identifying AAT cases which raise significant legal and policy issues and ensuring that they are brought to the attention of senior DSS and Services Australia officers’ (Recommendation 20.1). In its reports on the NDIA

Page 18

the Auditor-General does not seem to have specifically considered the application of the findings from the Robodebt Royal Commission to the NDIA or recommended that the NDIA adopt a system for identifying AAT cases which raise significant legal, policy or practice issues and ensuring that they are brought to the attention of the NDIA’s Board and management.

  1. The Auditor-General’s Interim Report on Key Financial Controls notes that an area of financial statement risk on which it is focused are the occurrence and accuracy (i.e. overstatement) of expenses.35 Overstatement of expenses can arise, inter alia, as a result of potentially fraudulent activities by NDIS participants or providers.

  2. Based on the reports of the Auditor-General reviewed in the preparation of this submission, including the Auditor-General’s Interim Report on Key Financial Controls, it does not appear that the Auditor-General has considered the potential financial statement risks arising from errors in the completeness and accuracy (i.e. understatement) of expenses paid to NDIS participants.

  3. During the audit planning and risk assessment process and the design of audit procedures the Auditor-General should have assessed whether the NDIA was understating expenses as a result of inappropriate decisions or calculations by the NDIA on the level of support it will fund.

  4. Assessing the risk of understatement of expenses by the Auditor-General should be important given errors by the NDIA would result in the NDIA withholding funding from some of the most vulnerable people in Australia. In addition, the Auditor-General should have assessed that the risk of the NDIA underfunding NDIS participants was high given the current environment in which there is strong public and political pressure to reduce the total expenditure of the NDIS, and when there are asymmetric outcomes as a result of incorrect decisions by the NDIA to reject, delay or underfund NDIS participants.

  5. In the current system where funding is always future oriented and no retrospective payments are made to NDIS participants where the NDIA makes an error, the NDIA always benefits. It’s a case of ‘Heads the NDIA wins; tails the NDIS participant loses’.

  6. Where the NDIA’s expenditure is understated because the NDIA fails to fund the appropriate level of reasonable and necessary services to those who are eligible NDIS participants, there is a risk that the NDIA and its board and management is failing to achieve the fundamental purpose of the NDIA: ’to provide reasonable and necessary support for people with disability’.36

  7. In June 2023 the Auditor-General appeared to acknowledge that there were errors in the NDIA’s funding decisions when it wrote that ‘Results of internal quality reviews of decisions to fund reasonable and necessary [ADL] supports are continually below target’ adding specifically that ‘the quality of decisions to fund [ADL] supports considered reasonable and necessary for participants’ needs have been below NDIA’s target of 75 per cent.’ 37 However the Auditor-General’s Report is silent on whether these ‘below target’ decisions resulted in the overstatement or understatement of the NDIA’s expenditure, a curious omission.

  8. Understatement of expenditure can be more difficult to test. Potential audit steps that could have been undertaken by the Auditor-General to test expenditure to NDIS participants for understatement include, for example:

  • Comparing plan expenditure for NDIS participants against a score determined by a relevant tool (such as WHODAS 2.038) that measures functional capacity and support

Review Audit Process

The use of this analytic review audit process would enable the Auditor-General to focus testing on outliers where a NDIS participant’s funding is materially different from the NDIS participant’s WHODAS score. It would have the added advantage of being able to test expenditure for both overstatement and understatement.

145. Recommendations

  • review of AAT/ART cases where the NDIA’s decision was overturned to understand the source of failure in the NDIA’s underlying processes;
  • review whether any actions were taken by NDIA’s management to modify its processes when the funding decisions of the NDIA were overturned by AAT/ART;
  • assessment of material differences in the average rate per hour in plans (or a sample of plans) compared to the NDIS price guide;
  • review of cases where the level of support funded by the NDIA was materially lower than that recommended by health professionals;
  • review of cases where an internal review by the NDIA has affirmed the original NDIA funding decision;
  • review of the accuracy and completeness of the NDIA’s process for calculating the level of support which it is funding; and
  • review of the NDIA’s policies, processes and practices for retaining documentation which supports its calculations of the level of support which it is funding.

Auditor-General’s Report Findings

The Auditor-General’s 2023 report into the ‘Effectiveness of the National Disability Insurance Agency’s Management of Assistance with Daily Life Supports’ noted:

‘The NDIA has a quality assurance program that assesses compliance with the NDIS Act 2013 (such as whether supports in plans are “reasonable and necessary”), participant experience and the quality of planning and decision-making.’

However, the Auditor-General’s 2023 report did not document what audit enquiries the ANAO made to discover what, if any, actions the NDIA’s quality assurance program took as a result of the high-level of NDIA decisions which were overturned at AAT to review whether NDIS participants were being underfunded.

The Auditor-General’s 2023 report documents the result of a review of the NDIA’s quality assurance program. In relation to errors made in the planning process, this report notes:

‘Plans with errors assessed as high-risk are returned to the relevant team for correction. Medium and low-risk plan issues are not corrected but are considered by the relevant group’s senior executives to identify priorities for any future agency-wide continuous improvement activity…’

This report further notes:

‘In ANAO’s 2021–22 financial statements audit, a recommendation was made for the NDIA to consider revising its processes to facilitate recording medium and low risk matters within CRM to ensure specific follow up action is undertaken with the participant and allow for plans to be easily varied in such circumstances.’ (para 2.69)

Our experience and that reported by many other participants suggests that in a substantial number of cases, rather than allowing for plans to be easily varied when errors have been made by the NDIA, the Agency affirms those planning errors in a section 100 review and then proceeds to defend them at ART.

Page 20

151.

The Auditor-General could also have enquired whether the NDIA had a system for identifying AAT/ART cases which raised significant legal and policy issues and ensuring they were brought to the attention of senior NDIA management and the NDIA Board, particularly when the implementation of such a system by a government body was a clear recommendation of the Robodebt Royal Commission.

152.

Organisational culture is recognised as a key element for an effective organisation and in assessing the effectiveness of Boards. Based on a review of the specific Auditor-General reports noted in the terms of Reference, it does not appear that the Auditor-General’s reports, including the Auditor- general’s Review of the Effectiveness of the Board of the NDIA$ dated 10 June 2025, have:

152.1.

specifically reviewed whether the NDIA board reflected on the findings and lessons of the Financial Services Royal Commission or the Robodebt Royal Commission; or

152.2.

considered whether findings and lessons from these Royal Commissions were relevant to the work completed as part of the Auditor-General’s reviews.

Conclusion

153.

The NDIS is a world-leading scheme to bring dignity to people with a disability. We appreciate the actions of the Committee to ensure that the NDIS is financially sustainable and the opportunity to share with the Committee our lived experience of the NDIA’s policies, processes and practices.

154.

We would be pleased to meet with members of the Committee if it required further information on any of the matters noted in this Submission.

Auditor-general Report No. 41 2024-25 Effectiveness of the Board of the National Disability Insurance Agency 19 | P a g e