‘Integrity of the National Disability Insurance Scheme’ submission 31/03/26
I’m a 38yr old fellowed GP who was medically retired 8yrs ago at age 31 due to multiple severe post-infectious chronic illnesses. As of Jan 2025, I have been an NDIS participant, so now have a perspective from both a health professional AND participant viewpoint.
Provider fraud seems common from my personal experience – mostly in the support work space (as opposed to allied health, plan management, or support coordination).
The most obvious example is the platform Hire Up, where I noticed that support shifts are all billed at the same set hourly rates (which change depending on day of week and time of day, public holidays etc – exactly the way the personal care NDIS service code does) regardless of what type of support was provided. You can see their set pricing on their website which reflects their inflexible and therefore non-compliant billing approach:
https://hireup.com.au/pricing/
I suspect Hire Up are coding every shift (whether it was domestic assistance, personal care, house & yard maintenance etc, or a combination of supports) as a personal care shift to increase revenue which is clearly both fraudulent and unethical (especially given it often unnecessarily/wrongly consumes more of participants’ NDIS funding which can lead to insufficient funds for essential supports and potential safety issues).
Hire Up needs to change its policies and processes. The Mable platform, for example, has a system where support workers specify the relevant code/s (it allows for a mixture) for each shift submission as per the support actually provided during that shift (aka compliant). For a Hire Up shift, the support worker simply specifies the hours worked (and whether there are any additional fees involved such as a travel fee), and Hire Up decides the coding far as I’m aware.
I’ve connected with hundreds of support workers over the last several years (I was privately funding essential support workers for 5yrs until I was ironically cognitively improved enough to finally apply for the NDIS), either virtually (discussing potential work) or for an actual trial shift.
The first 5yrs when organising my own privately funded support work through the Mable platform (which doesn’t have set rates like Hire Up), I had no unethical experiences. The private rates I was negotiating were sig below the NDIS price limits for those years.
Since being an NDIS participant (Jan 2025), a small minority (e.g. <10) of support workers on Mable (where you negotiate your own rates) have been unethical and either attempted to mislead or outright lied to me about NDIS rules. E.g. multiple people have told me the personal care service code is the correct code for a shift or job agreement when it most certainly was not (I suspect this is in order to receive more income and they are used to participants not being fully aware of the rules/service codes).
Lastly, in case it’s of interest, the allied health professionals or companies I’ve come across and all cleaners I’ve enquired with so far since being on the NDIS have treated the NDIS price limits not as a limit but as THE price. I guess it is natural that when a monetary limit is set, providers will have a tendency to charge the maximum they can.
I hope this information is helpful.