Structural Fraud Risk in Self-Managed Invoicing | External submission

Submission to the Joint Committee of Public Accounts and Audit

Submitted by: Assistive Tech Date: 19 January 2026

We’re The Glue Pty Ltd T/A Assistive Tech ABN 14 612 411 668 | ACN 612 411 668 support@assistivetech.com.au | assistivetech.com.au

Table of Contents

About Assistive Tech……………………………………………………………………………… 3
Inconsistent and Inaccurate Advice from the NDIA ………………………………………. 4
Outdated and Contradictory Public Guidance …………………………………………….. 6
Fragmentation Across 1,400+ Plan Managers ……………………………………………… 8 4.1 No Single Source of Truth ………………………………………………………………….. 8 4.2 Participants Are Conditioned to Shop for Approval ………………………………….. 8 4.3 Providers Cannot Design Compliant Systems ………………………………………… 8
Structural Fraud Risk in Self-Managed Invoicing ………………………………………… 10
Recommendations …………………………………………………………………………….. 12
Conclusion ……………………………………………………………………………………….. 13

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1. About Assistive Tech

Assistive Tech is an Australian Registered NDIS Provider specialising in assistive technology and communication supports for people with disability. We supply tablets, augmentative and alternative communication (AAC) tools, environmental controls, and related equipment to participants across Australia. We serve participants under self-managed, plan-managed and NDIA-managed arrangements alongside our work with retail and institutional customers.

Our business is built on compliance. We invest heavily in staff training, internal controls, conservative interpretation of the NDIS Act, Rules and Operational Guidelines, and participant education. Despite this, we encounter systemic barriers that make it difficult to ensure that claims lodged by participants and nominees are correct, lawful and consistent with NDIA expectations.

These barriers directly align with the Auditor-General’s finding that the NDIA was implemented with “catastrophically weak” prevention controls and that claim requirements remain unclear and inconsistently applied.

This submission focuses on four structural failure points that actively generate provider and claimant non-compliance:

Inconsistent and inaccurate advice from the NDIA.
Outdated and contradictory public guidance that lacks detail.
Fragmentation across 1,400+ plan managers.
A structural fraud gap in self-managed invoicing.

Each of these failures makes it harder for participants and providers to “do the right thing” and easier for error, misuse and opportunistic fraud to occur.

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2. Inconsistent and Inaccurate Advice from the NDIA

Participants and plan nominees routinely contact the NDIA National Contact Centre, Local Area Coordinators and Planners to ask whether a proposed purchase is:

A Funded Support;
A Replacement Support; or
Not an NDIS Support.

In practice:

The same question receives different answers on different calls and from different staff;
Advice is frequently incomplete or incorrect;
Participants are told “it’s fine to claim”, without reference to legislative tests; and
Providers are not included in these conversations and cannot verify what advice was given.

This creates three systemic problems.

Participants rely on oral advice. When a claim is later rejected or audited, the participant and the provider bear the risk - even though they acted in good faith based on information provided by the NDIA.
Providers are placed in an impossible position. We are expected to ensure compliance, yet we cannot rely on NDIA guidance given to the participant. If we refuse supply, we are perceived as obstructive. If we proceed, we risk facilitating non-compliance.
Good-faith errors become “misuse” in retrospect. Unclear guidance collapses the distinction between error and misuse and exposes participants to enforcement risk for conduct that was encouraged by NDIA staff.

Compounding this problem is the fact that NDIA-issued plans themselves are frequently ambiguous.

In our experience:

Plans often describe supports in broad, functional terms (for example, “assistive technology to support communication”), without:

o identifying the categories of permitted items; o referencing specific exclusions; or o linking the funding to any published interpretive guidance.
In practice, this means that a participant may be told their plan includes “assistive technology to support communication”, yet the plan does not state whether this

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includes a specific, concrete item such as an iPad with a communication app, a dedicated speech-generating device, or some other class of product.

Two participants with substantively identical needs may receive plans with materially different wording and structure.
The same plan may be interpreted differently by:

o the participant; o their plan manager; o their therapist; and o NDIA staff.

As a result, participants are routinely placed in the position of having to reverse-engineer legislative intent from high-level plan language or go back to the NDIA to request further clarification in writing delaying access to a much needed support. They are told that “your plan already covers this”, but no mechanism exists to determine what “this” actually includes in practice.

This means that even where a participant acts strictly “in accordance with their plan”, they may later be told that the support they believed was approved was never intended to be claimable.

A plan that does not clearly express:

what categories of goods and services are authorised; and
what classes of “everyday items” remain excluded,

is not a compliance instrument. It is an aspirational document.

When such ambiguity is combined with:

verbal advice;
outdated public guidance; and
fragmented interpretation across 1,400+ plan managers,

the scheme produces non-compliance not through bad faith, but through design.

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3. Outdated and Contradictory Public Guidance

Effective prevention controls require clear and specific claim requirements. In practice, the NDIA has acknowledged that its own published guidance is currently misaligned with the law. Providers and participants are routinely advised:

“The NDIA is updating all relevant published documents and guidance to align with the recent amendments to NDIS legislation. In the interim, the legislation remains the primary source of information to advise how NDIS funds can be used to purchase supports.”

The relevant legislative amendments became operable in October 2024. More than a year later, participants, nominees and frontline providers are still being told that:

Public NDIA guidance may be unreliable; and
Ordinary people should instead rely on primary legislation to determine what is claimable.

This is not a realistic or fair expectation in a consumer-facing social scheme.

Participants with disability, family carers, providers and plan managers are not lawyers. They cannot be expected to interpret statutory tests, transitional provisions and legislative intent in order to determine whether a support is claimable.

In reality, the NDIA website often:

Lags behind internal policy changes;
Contains examples that no longer reflect operational practice;
Omits clarifications provided in internal bulletins or training.

A concrete example is noise-cancelling headphones for participants that experience sensory overload as a consequence of their disability.

Participants with sensory processing disorders are frequently advised by therapists that noise- cancellation headphones are a reasonable and necessary way to support them. However:

Public NDIS guidance has at times suggested these are “everyday items”;
Private guidance to Assistive Tech from the NDIA is that these are personal items, and thus not a funded support;
Contact Centre staff provide conflicting interpretations;
NDIS Local Area Coordinators and Planners provide written advice to proceed with a claim;
Participants receive different outcomes depending on who processes the claim.

This results in:

Participants making claims in good faith based on public information;

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Providers attempting conservative interpretations and being accused of gatekeeping;
Retrospective debt notices where the same item has previously been approved.

Outdated guidance does not merely cause confusion—it actively generates non-compliance. The system invites error by design.

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4. Fragmentation Across 1,400+ Plan Managers

The current operating environment includes more than 1,400 plan managers, each with:

Their own internal policies and compliance thresholds;
Their own interpretation of the NDIS Act, Rules and Pricing Arrangements;
Their own approach to assessing suitability of an item for claiming everyday items with a disability-specific purpose.

In practice, this means:

The same invoice may be:

o Paid in full by one plan manager; o Partially rejected by another; o Completely refused by a third; o Escalated for “evidence” by a fourth.

4.1 No Single Source of Truth

There is no authoritative, binding interpretation of what is claimable in common edge cases. Instead:

Participants are told “your plan manager will decide”;
Providers are told “it depends who manages the plan”;
Plan managers themselves rely on informal NDIA guidance, peer groups and historical outcomes.

A support is not “compliant” or “non-compliant” in any objective sense - it is simply “allowed by this plan manager” or “claimed by this provider”.

This is not a control framework. It is regulatory outsourcing by default.

4.2 Participants Are Conditioned to Shop for Approval

Participants quickly learn that if one plan manager says “no”, another may say “yes”. This drives:

Churn between plan managers;
Escalation behaviour (“try someone else”);
Erosion of trust in the scheme’s fairness;
Normalisation of boundary-pushing.

The system trains participants to treat compliance as negotiable.

4.3 Providers Cannot Design Compliant Systems

For a registered provider attempting to operate lawfully at scale:

We cannot design a single compliant workflow;

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We must maintain dozens of parallel “rulesets”;
We cannot give definitive advice even when supports are clinically justified.

This creates perverse incentives:

Conservative providers lose sales to less conservative competitors;
The market rewards ambiguity;
Good-faith providers are commercially penalised for restraint.

It also creates operational waste through rework, bespoke justifications and policy-inconsistent rejections.

A national, rules-based scheme cannot function where 1,400 intermediaries independently decide what is “allowed”.

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5. Structural Fraud Risk in Self-Managed Invoicing

A significant integrity gap exists in the self-managed payment pathway.

Under current arrangements:

A self-managed participant requests an invoice from a registered provider.
The provider issues the invoice in good faith.
The participant submits the invoice to the NDIA for reimbursement.
The participant later cancels the order or does not pay the provider.
The provider has no visibility of whether the claim was lodged or paid.

This design creates a predictable and systemic risk:

The NDIA may reimburse the participant;
The provider may never be paid;
The provider has no mechanism to:

o Confirm whether a claim was submitted; o Confirm whether it was paid; o Prevent duplicate or fraudulent use of the invoice.

The only recourse available to the provider is to pursue a private debt against a person with disability - an outcome that is ethically fraught, commercially unrealistic, and inconsistent with the protective purpose of the NDIS.

This is not an edge case. It is a foreseeable failure mode in a system that separates:

Claim authority (participant),
Supply verification (provider), and
Payment visibility (NDIA).

There is no reconciliation loop between supply, claim and payment.

Proposed Reform: Provider-First Payment Model

Assistive Tech submits that the self-managed payment model should be reviewed with a view to the following principle:

Where a valid invoice from a registered provider is submitted to the NDIA, payment should be made directly to the provider unless the participant can demonstrate that they have already paid the provider and are seeking reimbursement.

Under this model:

A participant submitting an invoice would choose between:

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o “I have already paid and am seeking reimbursement”; or o “I authorise the NDIA to pay the provider directly”.

If reimbursement is selected, evidence of payment (e.g. receipt, bank confirmation or a copy of an invoice showing no outstanding balance) would be required.
Otherwise, payment would flow directly to the provider.

This reform would:

Eliminate invoice reuse and diversion of funds;
Protect participants from accidental debt and dispute;
Remove the need for providers to pursue vulnerable people for payment;
Align self-managed claims with the controls used in plan-managed and NDIA-managed pathways;
Create a closed-loop system linking supply, claim and payment.

Self-management should empower participants, not require the scheme to accept structural blind spots. A modern payment system can preserve choice while ensuring public funds reach the intended provider for the intended support.

Consequences for Scheme Integrity

Taken together, these failures:

Drive good-faith non-compliance;
Undermine provider willingness to engage with self-managed participants;
Incentivise overly conservative behaviour that reduces participant choice;
Create conditions for opportunistic misuse and fraud;
Shift risk onto the least powerful actors; participants and providers.

They directly contradict the objective of making it “easier to get it right and harder to get it wrong”.

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6. Recommendations

Assistive Tech recommends that the Committee consider:

Authoritative Written Advice All eligibility advice given by the NDIA should be:

o Recorded; o Referenced to policy; o Issued in writing following a contact centre call; o Accessible to the participant and nominated providers; o Binding for audit purposes.

Single Source of Truth NDIS guidance and policy must be:

o Published publicly to Providers, Plan Managers and Participants; o Versioned and dated; o Explicit when interpretations change.

Uniform Claim Rules Across All Pathways Claimability must be determined by a single, authoritative rule set applied uniformly across:

o NDIA-managed; o Plan-managed; and o Self-managed arrangements.

Plan managers should not function as de-facto regulators.

Provider-First Self-Managed Payments Where a valid invoice from a registered provider is submitted:

o By default, payment should be made directly to the provider; o Reimbursement should require evidence that the participant has already paid.

Error-Safe Design Where rules are ambiguous, the system should default to:

o Education rather than enforcement; o Prevention rather than retrospective debt.

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7. Conclusion

The NDIS cannot rely on post-hoc enforcement to correct systemic ambiguity. Prevention controls must be foundational.

From the perspective of a compliant provider operating at the frontline of the scheme, uncertainty is the single greatest driver of error, dispute and disengagement.

A sustainable NDIS must be designed so that ordinary people - participants, nominees and providers can confidently “do the right thing” without needing legal interpretation skills.

Assistive Tech welcomes the opportunity to provide further evidence to the Committee.

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