Submission to the Joint Standing Committee on the National Disability Insurance Scheme
Integrity of the National Disability Insurance Scheme: Structural Non-Compliance, Extractive Practices, and System Reform
Joint Standing Committee on the National Disability Insurance Scheme
Submission to the Integrity of the National Disability Insurance Scheme
Submitted by: Role/relationship to NDIS: Parent/carer/advocate of NDIS participant Mobile: , Email:
State/Territory: Victoria Date: 3 April 2026
- Executive Summary
This submission is based on lived experience navigating the National Disability Insurance Scheme (NDIS) over a six-year period as the parent and primary advocate of a participant with complex needs. My professional background includes law, psychology, and journalism and I approach this submission through the dual lens of lived experience and systemic analysis.
It makes the following central claim: The most significant integrity risk within the NDIS is not fraud in the traditional sense, but a systemically enabled model of lawful extraction, where providers maximise revenue through technically compliant but substantively exploitative practices.
At its core, this raises a fundamental question: What did policymakers expect from the introduction of a market-based model into disability support system?
The NDIS operates as a quasi-market system, where:
- participants are positioned as “consumers”
- providers compete for funding
- services are priced, itemised, and billed in units
In theory, market dynamics are intended to drive efficiency, improve quality, and increase choice and innovation. In practice, however, particularly in the context of disability support, this model is exploitative.
The Existing Market Model Encourages Exploitation
- through the volume of service delivery
- revenue maximisation
- the opportunistic use of pricing frameworks
Market systems do not reward:
- long-term participant outcomes
- reduced dependency
- ethical restraint
Within the NDIS, this translates into over-servicing, extractive billing strategies, fragmentation of services into chargeable units, and prolonged engagement without measurable progress. In our case my son’s plan started at approximately $15,000 in 2019 and ballooned to a $666,000 three-year plan from 2025. That’s not a success story, that’s a failure, particularly since the challenges from 2025 remain mostly unchanged. The main beneficiaries of this funding have been: providers.
Exploitative provider incentives and billing practices are not aberrations. They are predictable responses to the incentives embedded in the system.
This Is Particularly Harmful in the Disability Sector The application of a market model assumes:
- informed consumers
- equal bargaining power
- the ability to switch providers
These assumptions do not hold in the NDIS. Participants often:
- have complex cognitive, psychological, or functional impairments
- rely on providers for interpretation of the system itself
- face significant barriers to changing providers
This is not a market failure; it is a policy design failure that shifts both financial risk and regulatory burden onto participants and their families.
Core Integrity Issue
- exploitation occurs within the rules
- financial leakage is distributed and difficult to detect
- accountability is reactive and participant-driven
Reframing Non-Compliance: From Fraud to Extraction
The burden of identifying and resisting exploitation is placed on participants and their families, rather than on the system designed to protect them.
In any other context, this would be recognised as a misaligned market. In the context of disability support, it is ethically indefensible.
Reframing Non-Compliance: From Fraud to Extraction
The dominant issue is persistent, low-visibility financial extraction embedded within standard provider practices, which:
- comply with surface-level rules
- evade enforcement thresholds
- accumulate significant financial impact over time
These practices are normalised, difficult to challenge, and rarely subject to regulatory consequence.
Case Study Evidence
The following examples are de-identified and can be substantiated with documentation upon request.
Case Study 1: Systematic Billing Inflation via Non-Labour Travel
Over a period exceeding 12 months, a support work provider:
- billed non-labour travel at approximately 30% of total weekly charges
- provided no itemisation or explanation of: o travel purpose o distance o time allocation o or non labour activitiy
Impact:
- Tens of thousands of dollars in participant funding depleted
- No demonstrable link between non-labour travel charges and participant benefit
Systemic issue:
High-frequency, low-transparency billing categories can operate without scrutiny.
Case Study 2: Coordinated Financial Extraction
A support coordinator associated with the same provider:
-
advised that funding should be fully utilised to avoid reductions
-
described a method of fragmenting routine communications into billable units
-
promoted the rationale:
“If you don’t use the funding, you will lose it.”
Impact:
- Normalisation of unnecessary service activity
- Incentivisation of billing over outcomes
Issue:
The Scheme structurally rewards expenditure over effectiveness.
Billing Without Consent or Service Delivery
The same support coordinator:
- solicited feedback from us about why declined to renew the service agreement with them
- they then billed us for that interaction without disclosure or consent
Impact:
- Charging for provider-initiated activity
- Erosion of trust
Issue:
Weak boundaries around billable interactions enable monetisation of routine contact.
Case Study 4: Clinical Billing Misrepresentation
An allied health practitioner we had engaged:
- failed to meet service agreement obligations
- admitted to inaccurate billing practices described as “token billing”
- issued an invoice for four hours of work that did not occur
- withdrew the charges only after formal challenge
Impact:
- Attempted overbilling at clinical rates
- Reliance on participant intervention for correction
Issue: There is no proactive verification of service delivery against billing. The complaints and regulatory system are not fit for purpose
In July 2024, I submitted a documented complaint to the NDIS Quality and Safeguards Commission, including evidence of a provider’s misconduct and my efforts to resolve it directly with the provider.
Four months later, I received a one-line response: “We recommend you resolve the issue with the provider directly.” Case was closed.
This is not regulation. It is abdication.
The Commission’s inability or unwillingness to investigate clear evidence of risk creates: Provider impunity, Repeat harm to participants, Scheme-wide cost escalation, Loss of trust in the system.
System Failure
These examples reveal consistent structural failures:
Extraction Is the Norm, Not Exceptional
- Repeated overcharges
- Low visibility
- High cumulative loss
The System Relies on Participant Enforcement Participants and families are expected to:
- audit invoices
- interpret pricing rules
- challenge providers
This is inappropriate in a disability support system
Incentives Are Misaligned
Providers are rewarded for:
- activity
- time
- billing complexity
Not for:
- outcomes
- independence
- resolution
Regulatory Presence Is Weak
There is:
- limited proactive auditing
- minimal deterrence
- insufficient consequence for near-compliant misconduct
Impact on Participants and Families
The consequences are not only financial:
- Cognitive burden: constant monitoring and verification
- Emotional strain: ongoing disputes and vigilance
- System distrust: erosion of confidence in providers and NDIA
Critically:
Those with the highest needs are the least able to identify and challenge these practices.
Failure of Current Integrity Measures
Despite successive reforms, the system remains:
- reactive rather than preventative
- focused on documentation rather than behaviour
- unable to detect cumulative extraction
Compliance Framework
Required Structural Reforms
Mandatory Billing Transparency
- Itemised justification for all non-labour charges
- Standardised reporting formats
Independent Audit Mechanisms
- Randomised provider audits
- Cross-checking billing against service delivery
Prohibition of Extractive Practices
- Ban billing for unsolicited provider-initiated interactions
- Prohibit fragmentation of communications into billable units
Outcome-Based Accountability
- Link funding to measurable participant benefit
- Reduce incentives for passive, ongoing service delivery
Strengthen Practitioner Accountability
- Enforceable penalties for inaccurate billing
- Mandatory disclosure of billing corrections
- Tie billing to outcomes – not volume of repeat sessions
Complexity
- Streamline participant pathways
- Improve NDIA consistency
- Introduce clearer accountability mechanisms
Conclusion
Without reform: The system will continue to enable the extraction of public funds from those it is designed to protect, while requiring those same individuals to police it.
In any other sector, this would be recognised as systemic failure. Within disability support, it represents a failure not only of design, but of duty.
About Me
I bring lived experience as the parent and primary advocate for an NDIS participant with complex disability and mental health needs, alongside professional expertise in law, psychology, and journalism. My understanding of administrative law and service system design gives me a unique perspective on how procedural failures, unclear legal frameworks, and market-driven distortions affect vulnerable individuals. This submission draws not only on direct experience navigating the NDIS ecosystem, but also on a critical systems-level view of how governance, legal obligations, and accountability mechanisms are often misaligned in practice.