WESTERN AUSTRALIAN CONSUMER ADVOCACY

NETWORK

PREPARED ON BEHALF OF THE WACAN MEMBERSHIP BY REBEKAH PRICE

Introduction …………………………………………………………………………………………………………… 1 Summary Position ………………………………………………………………………………………………….. 1 Integrity as a Structural and Market Design Issue ……………………………………………………….. 2 Overcharging and Price Inflation as Systemic Outcomes ……………………………………………… 3 Exploitative Practices, Fraud, and Financial Abuse ……………………………………………………… 4 Implications for Integrity Reform ……………………………………………………………………………….. 6 Conclusion ……………………………………………………………………………………………………………. 6 References …………………………………………………………………………………………………………… 7

Introduction

The WA Consumer Advocacy Network (WACAN) welcomes the opportunity to provide a submission to the Joint Standing Committee on the National Disability Insurance Scheme (NDIS) inquiry into integrity.

WACAN is a network of consumer advocates, financial counsellors, and community legal centres across Western Australia, coordinated by the Consumer Credit Legal Service (WA). Our members provide direct services to individuals experiencing financial hardship, vulnerability, and systemic disadvantage, including people with disability participating in the NDIS.

This submission draws on:

aggregated frontline casework insights from WACAN member organisations, reflecting recurring patterns of consumer harm and systemic issues observed across multiple services and participants
observed systemic trends across consumer harm and financial exploitation
established principles in consumer protection, market regulation, and access to justice

WACAN’s central position is that integrity within the NDIS cannot be achieved through compliance and enforcement measures alone. Rather, integrity must be understood as a function of market design, regulatory coherence, and participant capability.

This submission addresses the Committee’s Terms of Reference relating to fraud, non- compliant and exploitative practices, and the effectiveness of current regulatory and integrity measures within the NDIS.

Summary Position

WACAN supports efforts to strengthen integrity within the National Disability Insurance NDIS. However, integrity must not be narrowly framed as a problem of fraud and non- compliance alone but must also address systemically enabled practices that operate within, rather than outside, existing rules.

WACAN’s position is that current integrity challenges within the NDIS arise from both intentional misconduct (including fraud), and a broader set of “sharp practices” that are enabled by structural market and system design failures. These sharp practices may be technically compliant with NDIS rules but nonetheless undermine participant outcomes and value for money. These include high levels of information asymmetry, limited price transparency, inconsistent regulatory oversight, and a system that is too complex for many participants to navigate without assistance.

These conditions create an environment in which:

overcharging and price inflation are normalised
low-to-mid level exploitative practices are widespread and difficult to detect
participants bear disproportionate responsibility for monitoring and enforcing compliance
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financial abuse and coercion can occur with limited safeguards

Evidence from the NDIS Review (2023), ACCC market observations, and NDIS Quality and Safeguards Commission reporting demonstrates that these issues are systemic and increasing in scale.

Accordingly, WACAN’s central submission is that integrity reform within the NDIS should not be approached primarily through expanded compliance and enforcement mechanisms. Instead, legislative and policy reform must address the underlying structural features of the Scheme that enable harmful but technically compliant practices, with the objective of supporting a fair, transparent, and effectively functioning market.

Integrity as a Structural and Market Design Issue

Current policy approaches to NDIS integrity are heavily oriented toward detecting and responding to fraud, misuse, and non-compliance. While these are legitimate concerns, this framing is insufficient to explain the scale and persistence of integrity issues observed within the NDIS.

WACAN submits that integrity challenges within the NDIS are more accurately understood as the result of structural features of the Scheme’s design, which create conditions in which exploitative conduct can emerge and persist. These conditions are well recognised in consumer protection and market regulation literature, particularly in markets characterised by vulnerability, complexity, and asymmetric information.

The NDIS incorporates several of these risk factors simultaneously.

Participants are required to navigate a system that is administratively complex, highly technical, and reliant on individual decision-making capacity. This includes interpreting funding categories, understanding pricing arrangements, negotiating service agreements, and monitoring expenditure. For many participants, particularly those with cognitive or psychosocial disability, this level of engagement is not realistically achievable without external support.

The 2023 Independent Review of the NDIS (Commonwealth of Australia, 2023) identified that the Scheme has become increasingly complex and difficult to navigate, noting that many participants are unable to exercise genuine choice and control without reliance on intermediaries such as support coordinators or plan managers. This reliance introduces additional layers of information filtering and decision-making, often shifting effective control away from participants themselves.

At the same time, providers operate with significantly greater access to information about pricing structures, service delivery models, and Scheme rules. This imbalance creates a classic case of information asymmetry, where one party to a transaction is substantially better informed than the other. Economic and consumer protection research consistently identifies such conditions as increasing the likelihood of inefficient market outcomes, including overpricing, reduced competition, and exploitative conduct.

The structural risks associated with complexity and limited comparability are well recognised in both disability policy and broader consumer market research. The 2023 Independent

Review of the NDIS found that participants often experience significant difficulty comparing providers, prices, and service quality, limiting the effectiveness of choice and control within the Scheme. Similarly, the Productivity Commission has identified that human services markets, including disability services, are characterised by information asymmetry and complexity, which constrain consumers’ ability to make informed choices and weaken competitive pressure on providers (Commonwealth of Australia, 2017). These conditions are evident within the NDIS and contribute directly to ongoing integrity risks

Overcharging and Price Inflation as Systemic Outcomes

WACAN members consistently observe that NDIS participants are charged significantly higher prices for services than would be expected in comparable non-NDIS markets. This issue is not limited to isolated instances of misconduct but reflects broader patterns of Pricing behaviour across multiple service types, including support coordination, allied health, and daily living supports.

The 2023 Independent Review of the NDIS identified that prices within the NDIS are frequently higher than in comparable markets, and that competitive pressures are not consistently effective in constraining pricing. The Review noted that participants often lack the ability to compare services on price or quality, limiting the effectiveness of market mechanisms intended to drive efficiency and value (Commonwealth of Australia, 2023).

Price caps, which are intended to function as consumer protection mechanisms, appear in practice to operate as price anchors, with providers clustering at or near the maximum allowable rate. This effect has been widely observed in regulated markets where price ceilings are interpreted as standard rates rather than upper limits.

The Productivity Commission has previously identified that in markets with limited competition and high information asymmetry; price regulation alone is insufficient to ensure efficient outcomes and may result in reduced price differentiation and limited downward pressure on costs (Commonwealth of Australia, 2017).

For NDIS participants, the consequences of sustained overpricing are significant. Higher unit costs result in the accelerated exhaustion of plan funding, reducing the duration and scope of supports available over the life of a plan. This can lead to:

unmet support needs
increased reliance on informal care
heightened financial and emotional stress

In thin markets, including regional and remote areas, these issues are further exacerbated. Participants may have little or no ability to choose between providers, effectively removing any remaining competitive constraint on pricing. The NDIS Review (2023) identified that market failure is particularly acute in these contexts, with participants often required to accept available services regardless of cost or quality.

Importantly, overcharging within the NDIS does not always arise from deliberate fraud or misconduct. Rather, it is often the result of:

limited transparency in pricing

lack of comparability between services
normalisation of maximum-rate billing practices
sharp practices

This distinction is critical. Integrity risks within the NDIS are not confined to non-compliant (or unlawful) behaviour but also include systemically enabled practices that undermine value for money and participant outcomes.

WACAN submits that addressing overcharging requires more than enforcement action against individual providers. It requires structural reform to improve transparency, comparability, and market function within the Scheme.

Exploitative Practices, Fraud, and Financial Abuse

WACAN members report that, alongside systemic overcharging, NDIS participants are increasingly exposed to a range of exploitative practices that extend beyond pricing concerns. These practices exist on a spectrum, from poor practice and opportunistic behaviour through to deliberate fraud and financial abuse. While high-profile cases of fraud have attracted public and regulatory attention, frontline experience indicates that lower-level, repeated exploitative conduct is more prevalent and more difficult to detect. These practices are not always unlawful, but are often facilitated by gaps in transparency, oversight, and participant capability within the current system.

The NDIS Quality and Safeguards Commission has reported ongoing growth in complaints relating to provider conduct, including issues of service non-delivery, inappropriate charging, and financial exploitation (Commonwealth of Australia, 2025).

WACAN members’ casework reflects these trends, with participants experiencing:

billing for services not delivered or only partially delivered
inflation of service duration or intensity beyond what was provided
duplicate or unclear charging across funding categories
pressure to approve invoices or service agreements without adequate understanding
difficulties in getting a satisfactory resolution when issues arise

These practices are often facilitated by the structural conditions outlined earlier in this submission, particularly:

information asymmetry between providers and participants
limited real-time visibility over plan expenditure
complexity of pricing and billing arrangements

In many cases, participants cannot identify or challenge these practices. This is particularly evident where participants:

have cognitive or psychosocial disability
rely heavily on providers or support coordinators
lack access to independent advocacy or financial capability supports

The result is a system in which participants are expected to act as the primary safeguard against misuse of funds, despite often lacking the tools, information, or capacity to do so effectively.

Beyond provider misconduct, WACAN is also concerned about the intersection between the NDIS and financial abuse, particularly in situations where informal supports, family members, or carers have access to or influence over a participants funding.

Research consistently demonstrates that people with disability are at increased risk of financial exploitation and coercion, particularly where decision-making capacity is impaired, or support relationships are imbalance.

The design of the NDIS, which places control of significant funding in the hands of individuals without always providing adequate safeguards, can inadvertently create opportunities for such abuse to occur. WACAN members report instances where:

participants are pressured to approve payments or engage particular providers
funds are used in ways that do not reflect the participant’s needs or preferences
service agreements are entered into without informed consent

From a consumer protection perspective, these issues raise concerns regarding:

unconscionable conduct
undue influence
lack of informed consent in contractual arrangements

However, existing enforcement and redress mechanisms are not readily accessible to many participants. Complaints processes can be complex and time-consuming, and there is often uncertainty regarding whether issues fall within the jurisdiction of the NDIS Safety and Quality Commission, the National Disability Insurance Agency, or broader consumer law frameworks.

This fragmentation of oversight contributes to underreporting and limits accountability.

Importantly, WACAN emphasises that the harms arising from these issues are not solely the result of individual bad actors. Rather, they are enabled by a system that:

places significant responsibility on participants to monitor and enforce compliance
lacks consistent, proactive safeguards
does not provide sufficient transparency or oversight of financial transactions

As a result, exploitative practices can persist at scale without detection or consequence.

WACAN submits that strengthening integrity within the NDIS requires a shift from reactive enforcement toward proactive prevention of harm, including improved monitoring, clearer accountability, and stronger safeguards for participants at risk of exploitation.

Implications for Integrity Reform

WACAN is concerned that current and emerging responses to integrity risks within the NDIS are increasingly focused on compliance, monitoring, and enforcement mechanisms, without sufficient attention to the underlying structural drivers of harm.

While targeted compliance activity is necessary, an over-reliance on enforcement may cause unintended consequences for participants, including:

reduced flexibility in how supports are accessed and delivered
delays in accessing essential services
increased administrative burden on participants, particularly those who self-manage or rely on plan management

These impacts are not evenly distributed. Participants with higher or more complex needs, as well as those with limited support networks, are more likely to experience adverse effects from increased system rigidity.

Without addressing issues of transparency, comparability, and market function, compliance- based approaches are unlikely to resolve systemic integrity risks. Instead, they may shift the burden of risk management further onto participants, reinforcing existing inequities within the Scheme.

WACAN submits that integrity reform should prioritise:

improving transparency of pricing and service delivery
reducing system complexity to support informed decision-making
strengthening proactive safeguards against financial exploitation
ensuring consistent regulatory oversight across all providers

A system that is easier to understand, navigate, and monitor will inherently reduce opportunities for misuse and improve participant outcomes.

Conclusion

Integrity within the NDIS cannot be understood solely as the prevention of fraud. It is fundamentally linked to whether the NDIS operates in a way that is transparent, accessible, and capable of protecting participants from harm.
WACAN’s experience demonstrates that current integrity challenges are driven not only by individual misconduct, but by structural features of the Scheme that enable overcharging, exploitation, sharp practices and financial harm.
Addressing these challenges requires a shift in focus from reactive enforcement to proactive system design. Without reform to improve market function, reduce complexity, and strengthen participant safeguards, integrity measures alone will not achieve sustainable outcomes.
A well-functioning NDIS is not only one that prevents misuse, but one that enables participants to exercise genuine choice and control, with confidence that they are receiving fair value and appropriate supports.

References

Commonwealth of Australia. (2017). Introducing Competition and Informed User Choice into Human Services: Reforms to Human Services. Canberra: Productivity Commission.

Commonwealth of Australia. (2017). National Disability Insurance Scheme (NDIS) costs. Canberra: Productivity Commission.

Commonwealth of Australia. (2023). Final Report. Canberra: Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability.

Commonwealth of Australia. (2023). Working together to deliver the NDIS. Canberra: NDIS Review.

Commonwealth of Australia. (2025). NDIS Quality and Safeguards Commission Annual Report 2024-25. Canberra: NDIS.