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Australian Orthotic Prosthetic Association (AOPA) Submission

Joint Standing Committee on the NDIS PO Box 6100 Parliament House Canberra ACT 2600 ndis.joint@aph.gov.au

Dear Joint Standing Committee on the National Disability Insurance Scheme,

The Australian Orthotic Prosthetic Association (AOPA) welcomes the opportunity to provide input to the Joint Standing Committee’s inquiry into non-compliance, fraud, and scheme integrity within the National Disability Insurance Scheme (NDIS).

The Australian Orthotic Prosthetic Association (AOPA) is the peak professional body for certified orthotist/prosthetists. AOPA is responsible for regulating the profession and is a founding member of the National Alliance of Self Regulating Health Professions (NASRHP). AOPA is recognised by the Commonwealth Government as the assessing authority responsible for conducting migration skill assessments for orthotists/prosthetists.

Orthotic and prosthetic services are clinically prescribed, highly specialised assistive technology interventions that directly interface with the body. As such, they represent a high-risk category of supports where inappropriate provision can result in significant harm.

AOPA’s submission focuses on:

the nature of clinical non-compliance within assistive technology provision
the impacts of these practices on participant safety and Scheme integrity

AOPA’s submission emphasises the need for improved information sharing between the NDIS and regulatory bodies like AOPA, around the area of non-compliant practice, along with the need to ensure that orthoses and prostheses are provided by competent providers.

A summary of recommendations is provided, and we welcome the opportunity to share further details or present to the Committee if invited. Please contact, redacted for further information or questions arising from the following submission.

Yours sincerely,

Jessica Landers

Chief Executive Officer Australian Orthotic Prosthetic Association

1.0 Introduction

This submission outlines AOPA’s observations regarding integrity risks within orthotic and prosthetic service provision under the NDIS, and proposes practical, risk-based reforms to address these issues.

The submission is structured to:

outline the nature and drivers of non-compliance in clinically complex assistive technology
describe the impacts of these practices on participants and Scheme outcomes
identify gaps in current oversight and regulatory arrangements
present targeted recommendations to strengthen integrity while maintaining appropriate access to care

AOPA’s focus is on areas where clinical risk is highest and where strengthened professional oversight can deliver meaningful improvements in both safety and Scheme performance.

1.1 About Certified Orthotist/Prosthetists

Certified orthotists/prosthetists are tertiary-qualified allied health professionals (minimum AQF Level 7) who provide orthotic, prosthetic and assistive technology services to Australians, including NDIS participants. They assess participants’ physical abilities, functional capacity, goals, environment and broader health context, and support informed decision-making about appropriate orthotic, prosthetic or assistive product supports, balancing safety, function, durability and long- term outcomes. Care extends beyond product selection/prescription to encompass assessment, prescription, custom design, coordinating fabrication, fitting, training, education and lifecycle review, with orthoses and prostheses routinely modified in response to growth, ageing, clinical change or environmental demands. Orthotists/prosthetists work across public, community and private settings, including rural and remote areas, and within multidisciplinary teams to deliver person-centred care that supports independence, participation and quality of life.

2.0 Summary of recommendations

AOPA broadly supports efforts to strengthen integrity within the NDIS. However, we emphasise that integrity measures must be risk proportionate. AOPA’s core position is that Scheme integrity must be strengthened through targeted, risk-based reform, rather than broad, uniform controls.

AOPA makes two key recommendations that the NDIS should:

Recommendation 1: Establish formal information-sharing mechanisms with professional peak bodies that are responsible for certification and complaints management as regulators for their professions.

Recommendation 2: Ensure that orthotic and prosthetic interventions are provided by appropriately qualified and competent professionals through recognition of AOPA Certification for orthotic/prosthetic providers.

3.0 Nature and Extent of Non-Compliance

In the context of orthotic and prosthetic services, AOPA notes that, as the professional body responsible for both certification and complaints management, we are not aware of substantiated cases of fraud involving Certified orthotists/prosthetists within our regulatory remit. AOPA has not received any formal complaints of this nature.

However, AOPA maintains ongoing engagement with members and sector advisory groups, including the Private Practice Reference Group and we also employ Clinical Practice Advisors on our staff team, who are also currently providing clinical orthotic and prosthetic services. For the purposes of this submission, AOPA sought feedback from these groups and received anecdotal reports of practices that may raise integrity concerns within the Scheme.

While these reports do not constitute formal complaints and have not been independently substantiated, they provide important insight into emerging risks that may not yet be visible through existing compliance and reporting pathways. These insights suggest the presence of behaviours that could be characterised as “sharp practices”, particularly in areas where clinical oversight is limited or system settings create opportunities for misuse. This highlights a broader challenge for Scheme integrity: that early indicators of non-compliance often emerge through professional and clinical networks before they are captured through formal regulatory mechanisms. As such, there is value in recognising and appropriately responding to these signals as part of a proactive, risk-based integrity framework.

In the context of orthotic/prosthetic service provision, integrity risks are often not driven by overt fraud, but by practices that act as work-arounds to fill gaps in regulatory and clinical oversight. These may include misrepresentation of products, provision outside scope of practice, and fragmentation of care. While not always constituting deliberate deception, such practices can result in unsafe, ineffective, or low-value supports.

These behaviours are often less visible to traditional compliance mechanisms, which tend to focus on billing and documentation rather than clinical appropriateness or quality of care. Despite this, they can have significant consequences for participant safety and Scheme sustainability, particularly in areas involving clinically complex assistive technology.

As the regulatory body for orthotists/prosthetists in Australia, AOPA considers that improved information sharing from the NDIS in relation to identified integrity concerns would strengthen AOPA’s ability to support compliance. AOPA maintains a well-established complaints and disciplinary process appropriate for managing these matters.

Improved information-sharing would support:

earlier identification of systemic issues
stronger professional accountability

alignment between Scheme integrity mechanisms and existing professional standards frameworks

The NDIA should establish formal mechanisms to share relevant complaints, notifications, and integrity concerns with appropriate professional peak bodies like AOPA, where these relate to their members, or areas of professional oversight.

This should include:

Timely sharing of complaints and concerns relating to clinical practice, safety, or professional conduct
Mechanisms for escalation where issues may indicate systemic risk or repeated behaviours
Appropriate safeguards to ensure privacy and procedural fairness

Currently, professional bodies such as AOPA have limited visibility of complaints made directly to the NDIA. This creates a gap in the early identification of emerging risks, particularly in high- risk clinical areas such as orthotic and prosthetic service provision.

Recommendation 1: Establish formal information-sharing mechanisms with professional peak bodies that are responsible for certification and complaints management as regulators for their professions.

While AOPA does not have visibility over all forms of non-compliance within the NDIS, in subsequent sections of this document we highlight the following integrity risks within assistive technology markets, particularly where appropriate clinical safeguards are not consistently applied.

3.1 Unqualified Provision of Orthoses, Prostheses and Assistive Products

AOPA regularly receives reports from both Certified orthotists/prosthetists and the Australian community about the provision of orthoses and prostheses, and assistive products by those without the required qualifications, certifications or competencies to do so. From this, we can understand that there are increasing instances of clinical non-compliance within assistive technology service provision, particularly in relation to orthotic and prosthetic interventions, where supports are clinically complex and require specialist expertise to deliver safely.

These risks arise in contexts where individuals or organisations without appropriate clinical training or recognised professional certification undertake activities that would typically fall within the scope of qualified orthotists/prosthetists.

This includes:

Provision by non-qualified providers, where individuals or organisations without appropriate clinical training or AOPA Certification undertake assessment, prescription, or supply of orthoses and/or prostheses
Situations where providers may be registered NDIS providers, but do not possess the specific competencies required to deliver clinically appropriate orthotic/prosthetic services
Delivery of services without adherence to established clinical processes, including comprehensive assessment, biomechanical evaluation, fitting, user training, and ongoing review

Orthotic and prosthetic interventions are clinically prescribed, body-interfacing assistive products, where outcomes are highly dependent on appropriate clinical expertise. When these services are delivered outside of recognised professional standards, there is an increased risk of:

inappropriate or unsafe device provision
reduced functional outcomes
avoidable complications requiring further intervention

Importantly, participants may not be able to distinguish between qualified and non-qualified providers, particularly where providers are registered within the NDIS. This creates a risk that NDIS registration is interpreted as an indicator of clinical competence, which is not necessarily the case when current arrangements do not prevent individuals without appropriate qualifications from registering and presenting as providers.

This risk is further compounded by the absence of protection of title for the professions of orthotist/prosthetist in Australia. Unlike some other allied health professions, there are currently no legislative restrictions on the use of these professional titles. As a result, individuals or organisations may present themselves as orthotists or prosthetists, or as providers of orthotic/prosthetic services, without holding recognised qualifications, meeting established competency standards, or being subject to professional oversight.

In practice, this creates a significant information asymmetry within the NDIS market. Participants, families, and even other stakeholders may reasonably assume that the use of professional titles, or the provision of services within a registered provider framework, indicates an appropriate level of clinical expertise. However, in the absence of title protection or mandatory certification requirements, this is not assured.

In the context of orthotic and prosthetic interventions, which are clinically prescribed, body- interfacing supports with a high risk of harm if delivered inappropriately, this gap represents a material integrity and safety concern. It enables the potential for unqualified provision to occur under the appearance of legitimacy and limits the ability of participants to make informed decisions about their care.

Strengthening requirements for appropriately qualified providers, including recognition of AOPA Certification, would provide an effective and proportionate mechanism to address this risk. It would support clearer differentiation between qualified and non-qualified providers, improve participant safety, and align service delivery with established clinical standards.

Recommendation 2:

Ensure that orthotic and prosthetic interventions are provided by appropriately qualified and competent professionals through recognition of AOPA Certification for orthotic/prosthetic providers.

3.2 Representation of orthoses and prostheses

Misrepresentation of assistive technology interventions may represent an emerging integrity risk within the NDIS, particularly in relation to orthotic and prosthetic interventions, where products are clinically complex and require specialist expertise to prescribe and deliver safely. Based on sector insights and professional experience, this risk may arise in contexts where appropriate clinical oversight is limited or where services are delivered outside recognised scopes of practice.

Potential areas of concern may include:

Billing for custom devices where limited customisation has occurred, including situations where off-the-shelf products are minimally adjusted but described or understood as bespoke, clinically prescribed orthoses
Substitution of prescribed devices, where the product supplied may not fully align with the clinical specification or intended functional outcomes identified during assessment
Provision of devices without adequate fitting, adjustment, or user training, particularly where qualified orthotists/prosthetists are not involved across the full-service pathway

While AOPA has not received formal complaints or substantiated evidence of these practices, these scenarios highlight areas where gaps in clinical oversight could create risks to both Scheme integrity and participant outcomes.

Orthotic and prosthetic devices are not standard consumer goods, they are individually prescribed, body-interfacing interventions, where outcomes are highly dependent on specialist clinical expertise. Where appropriate safeguards are not in place, there is potential for:

Inefficient use of Scheme funding; and
Reduced clinical effectiveness or safety for participants

Importantly, participants are often not in a position to independently verify whether a product has been appropriately customised or supplied in accordance with clinical recommendations. This creates an inherent information asymmetry, reinforcing the importance of qualified providers and appropriate regulatory oversight.

The risks outlined above would be effectively mitigated through the implementation of Recommendations 1 and 2, which together strengthen information-sharing, professional

oversight, and the role of appropriately qualified providers in high-risk assistive technology provision.

3.3 Sharp practices

AOPA notes the presence of behaviours that may be characterised as “sharp practices” within assistive technology provision under the NDIS. These practices do not necessarily meet the hreshold of fraud but may involve the deliberate or opportunistic use of system settings in ways that are not aligned with the intent of Scheme safeguards.

Based on sector engagement and professional insights, these practices may include:

Invoicing approaches that may avoid or minimise approval thresholds, such as distributing costs across multiple service dates or claims
Structuring of service delivery or billing arrangements in ways that obscure the true cost, scope, or nature of supports provided
Leveraging administrative or pricing gaps to maximise revenue in ways that are not aligned with clinical need or participant outcomes

While AOPA has not received formal complaints or substantiated evidence of these practices, these observations highlight areas where current system settings may create unintended opportunities for behaviour that does not align with the objectives of the Scheme. These behaviours can be difficult to detect through conventional compliance mechanisms, which often focus on individual transactions rather than patterns of behaviour over time. As a result, they may persist undetected while contributing to inefficiencies and inequities within the Scheme.

Importantly, these practices may also result in inaccurate or distorted data being reported back to the NDIA regarding the cost and structure of service delivery. Where costs are fragmented, misrepresented, or not aligned with the true nature of clinical services, this can undermine the NDIA’s ability to develop an accurate understanding of the real cost drivers associated with assistive technology provision. Over time, this may impact pricing decisions, market stewardship, and policy settings, particularly in areas where reliable cost benchmarks are already limited.

Addressing these risks requires a shift from purely transactional compliance toward more holistic, risk-based monitoring approaches that consider provider behaviour, service patterns, and alignment with clinical intent.

Implementation of Recommendations 1 and 2 would provide a proportionate and effective mechanism to address these risks by improving oversight and reducing opportunities for misuse within high-risk assistive technology provision.

3.4 Fragmentation of Service Provision

Fragmentation of service provision is an emerging integrity and safety risk within the NDIS, particularly in areas involving clinically complex assistive technology. This occurs where clinical

services (assessment, prescription, monitoring and follow up) are separated from the supply and delivery of assistive technology, without clear clinical oversight or accountability across the full service pathway.

Orthotic and prosthetic interventions are inherently integrated clinical services, where outcomes depend on continuity between assessment, design, fabrication, fitting, and follow-up. Where these services are delivered by appropriately qualified orthotists/prosthetists within established clinical frameworks, accountability is clear and risks are significantly mitigated.

However, where system settings allow or encourage fragmentation, particularly in the absence of requirements for appropriately qualified providers, these safeguards may not be consistently maintained.

This highlights a gap in current integrity frameworks, where supports may be delivered, but clinical responsibility, safety, and outcomes are not clearly assured.

The risks outlined above would be effectively mitigated through the implementation of Recommendations 1 and 2, which reinforce the role of AOPA Certified providers and the integration of clinical services with orthotic and prosthetic provision.

4.0 Impacts on Participants and Families

Integrity risks within orthotic and prosthetic service provision can have direct and immediate consequences for participants and their families. Given that these interventions are body- interfacing, clinically prescribed supports, the impacts extend beyond financial inefficiency to include tangible risks to safety, health, and long-term outcomes.

4.1 Physical Harm

Inappropriate prescription, design, or fitting of orthoses and prostheses can result in significant physical harm to participants.

This may include:

Falls and instability, particularly where devices do not provide adequate support or alignment
Pressure injuries and skin breakdown resulting from poor fit or inadequate follow-up
Joint damage, altered biomechanics, and long-term deformity where devices are incorrectly prescribed or adjusted
Reduced mobility, independence, and participation in daily activities

These outcomes can have compounding effects over time, particularly for participants with complex or progressive conditions, and may require further clinical intervention to resolve.

4.2 Financial Harm

Non-compliant or poor-quality provision of orthoses and prostheses can result in inefficient use of participant funding and broader Scheme resources.

Participants may:

Exhaust funding on devices that are ineffective, inappropriate, or unsafe
Require replacement or modification of devices earlier than expected due to poor initial provision
Incur additional health system costs associated with complications, such as wound care, hospitalisation, or corrective treatment

For participants with limited plan budgets, these impacts can restrict access to other essential supports, further affecting overall outcomes and quality of life.

4.3 Loss of Trust in the Scheme

Experiences of poor-quality or unsafe assistive technology provision can undermine participant confidence in both providers and the NDIS more broadly.

This may result in:

Reduced willingness to engage with providers or seek further support
Hesitancy to trial new or clinically appropriate interventions
Erosion of trust in the Scheme’s ability to deliver safe, effective, and participant-centred care

For families and carers, this can increase the burden of navigating the system and advocating for appropriate supports, particularly where clinical complexity and information asymmetry are high.

5.0 Conclusion

AOPA supports efforts to strengthen integrity within the NDIS and recognises the importance of ensuring that Scheme resources are used effectively and in the best interests of participants. However, this submission highlights that, in the context of orthotic and prosthetic service provision, integrity risks are not typically driven by substantiated fraud, but by less visible practices arising from gaps in clinical oversight, system design, and provider capability.

These risks are particularly significant in high-risk, body-interfacing assistive technology, where the consequences of inappropriate provision are directly borne by participants through impacts on safety, function, and long-term health outcomes. As outlined in this submission, issues such as unqualified provision, misrepresentation, fragmentation of care, and the emergence of “sharp practices” are often not readily detected through traditional compliance approaches but can have substantial implications for both participant outcomes and Scheme sustainability.

AOPA’s position is that these challenges are best addressed through targeted, risk-proportionate reform. Strengthening information-sharing, reinforcing the role of appropriately qualified providers, and ensuring the integration of clinical services with assistive technology provision are critical to improving both safety and accountability within the Scheme.

The recommendations outlined in this submission provide a practical and proportionate framework to:

improve visibility of emerging risks
strengthen professional and clinical oversight
support appropriate and effective use of Scheme funding
enhance participant confidence and trust

By focusing on high-risk areas and aligning integrity measures with clinical complexity, the NDIS can strengthen safeguards without imposing unnecessary burden across the broader system.

AOPA welcomes continued engagement with the Committee and the NDIA to support the development and implementation of reforms that improve participant outcomes and strengthen Scheme integrity.

ORTHOTIC PROSTHETIC

THE AUSTRALIAN ASSOCIATION

The Australian Orthotic Prosthetic Association P.O. Box 1132 Hartwell, Victoria 3124 (03) 9816 4620 | www.aopa.org.au