Submission 1784

Submission: Securing the NDIS for Future Generations Bill 2026

To: Committee Secretary (Confidential) Subject: Systemic Misuse, Diagnostic Inflation, and Structural Reform

1. Executive Summary

The NDIS is being undermined by a combination of:

• Weak eligibility controls
• Provider overbilling and low accountability
• Diagnostic inflation driven by funding incentives
• Cost-shifting from mainstream systems
• Misuse of supports beyond disability-related needs

At the same time, public funds are being diverted into legal disputes by the National Disability Insurance Agency rather than frontline support.

If left unaddressed, these failures will:

• Erode public trust
• Divert funding from participants with genuine, significant disability
• Create long-term fiscal instability

This submission proposes targeted, enforceable reforms to restore integrity without disadvantaging those with legitimate needs.

2. Core Problem: A System That Rewards Gaming Over Need

The current design of the NDIS has created perverse incentives:

• Diagnosis unlocks funding, creating pressure to secure labels rather than demonstrate functional impairment
• Providers are financially rewarded for maximising billable hours, not outcomes
• Vague rules enable reinterpretation of supports as “disability-related”
• Participants face reduced supports without formal diagnoses, encouraging escalation

This is not an isolated misuse. It is system-enabled behaviour.

Submission 1784

Diagnostic Inflation and Autism Access Pressures

There has been a significant rise in autism diagnoses since the introduction of the NDIS.

While increased awareness plays a role, the scheme has also created clear structural incentives:

• Long-term funding tied to diagnosis
• Limited supports available without formal eligibility
• Abrupt withdrawal of early intervention supports

This has contributed to:

• Over-reliance on single-discipline assessments
• Pressure on clinicians to diagnose
• Expansion of diagnostic thresholds in practice

Key Position

This is not a critique of autism. It is a critique of a system that rewards diagnosis over demonstrated functional need.

Misuse of Supports and Cost-Shifting

Support Workers

Support workers are increasingly used for:

• Babysitting and passive supervision
• School drop-offs and pick-ups
• Daytime care during school hours

This represents a shift of parenting and education responsibilities into the NDIS.

Consumables

Consumables funding has expanded beyond intent to include:

• Everyday household items
• Non-disability-related purchases

Submission 1784

• High-risk recreational equipment (e.g. trampolines, swing sets, monkey bars)

This is a failure of enforcement, not policy ambiguity.

4.3 Provider Billing Practices

Common patterns include:

• Excessive charging for case notes and session planning
• Inflated travel claims
• High-frequency low-value billing

This results in systemic financial leakage at a scale.

4.4 Misclassification of Parental Responsibilities as Funded Supports

A further and significant concern is the inclusion of ordinary parental responsibilities within children’s NDIS plans.

There are increasing instances where funding is being used for:

• Lawn maintenance and gardening
• General household cleaning
• Swimming lessons presented as therapy

These are not disability supports. They are ordinary family responsibilities.

Household Tasks

No child’s NDIS plan should include:

• Lawn maintenance
• Gardening
• General domestic cleaning

These are responsibilities of the household and should not be funded under the Scheme unless there is a direct, evidenced link to the child’s functional impairment that cannot reasonably be managed through informal support.

Submission 1784

Swimming Lessons vs Therapy

There is also a growing misuse of therapeutic supports, particularly:

• Hydrotherapy
• Physiotherapy

as a pathway to fund effective swimming lessons.

While hydrotherapies and physiotherapies have legitimate clinical purposes, they are increasing being used to:

• Circumvent funding restrictions
• Reclassify recreational or developmental activities as therapy

This undermines the integrity of therapeutic support.

Key Distinction

• Therapy must be clinically prescribed, outcome-focused, and directly linked to functional goals
• Swimming lessons are a general developmental activity and a parental responsibility

Commercialisation of Disability Through High-Cost Programs

A growing concern is the expansion of high-cost, non-evidence-based programs marketed to NDIS participants—particularly children—under the guise of therapy or skill development.

These include:

• School holiday programs run by occupational therapists at extremely high hourly rates
• Activities such as:
  • Learning to ride a bike
  • Surfing
  • Fishing
  • Art classes

Submission 1784

While these activities may have general developmental value, they are being:

• Rebranded as therapeutic interventions, and
• Charged at specialist therapy rates

In many cases, these same activities could be:

• Safely and effectively facilitated by a support worker at a fraction of the cost, or
• Undertaken as part of normal family and community participation

4.6 Profit-Driven Programs Targeting Disability

There is also a noticeable increase in companies developing NDIS-targeted programs, including:

• Camps
• Fishing trips
• Boat charters
• Group activity programs marketed specifically to autistic participants

These programs are often:

• Packaged as “capacity building”
• Delivered at premium prices
• Poorly defined in terms of measurable outcomes

Key Concern

The Scheme is increasingly being used as a funding stream for commercial ventures, rather than a targeted support system.

This raises a fundamental question:

Where is the evidence base?

4.7 Evidence Gap and Lack of Accountability

Many of these programs:

• Lack peer-reviewed or clinically validated evidence
• Do not demonstrate measurable functional outcomes

Submission 1784

• Are not subject to consistent evaluation

Yet they continue to attract significant funding.

This creates:

• A market incentive to design programs for profit, not need
• Reduced funding availability for participants requiring essential supports

5. Legal Expenditure Misallocation

The National Disability Insurance Agency is expending significant public resources on:

• Lawyers and barristers
• Adversarial tribunal processes

This approach:

• Disadvantages self-represented participants
• Redirects funding away from supports
• Fails to resolve disputes efficiently

6. Reform Framework

6.1 Eligibility Reform (Stricter Access)

Access must require:

• Permanent and significant functional impairment
• Standardised functional assessments
• Independent verification where required

Diagnosis alone must not determine eligibility.

6.2 Short-Term Respite (Safety Valve)

Introduce capped Short-Term Respite (STR):

• 4–12 weeks maximum
• For acute need or carer breakdown
• Non-renewable without reassessment

Submission 1784

Purpose: prevent escalation without granting long-term access inappropriately

6.3 Diagnostic Integrity Controls

• Mandatory multidisciplinary assessment for autism
• Independent review of inconsistent reports
• Monitoring of high-diagnosis providers

Funding must align with functional impact, not diagnostic labels.

6.4 Provider Regulation

• Mandatory registration (tiered by risk)
• Unique provider identifiers
• Public performance and compliance records

6.5 Billing Controls

• Cap non-face-to-face billing (e.g. case notes)
• Restrict session planning charges
• Enforce travel limits and verification
• Require itemised, time-stamped invoices

6.6 Consumables Restrictions

Consumables limited to:

• Disability-specific supports
• Adaptive and assistive items

Explicit exclusions:

• Everyday items
• Household goods
• High-risk recreational equipment

6.7 Support Worker Limits (Children)

Support workers must not be used:

Submission 1784

• During school hours for children capable of attending school
• For parenting or supervision roles
• For school transport (unless disability-specific or ineligible Assisted School Travel Program)

Exception:

• Homeschooling or documented inability to attend school

Clarification of Parental Responsibility (Children’s Supports)

Legislation or Rules must explicitly state:

NDIS funding for children must not include:

• Lawn maintenance or gardening
• General household cleaning
• Recreational or developmental activities ordinarily expected of families, including swimming lessons

Therapeutic Support Integrity

To prevent misuse of therapy funding:

• Hydrotherapy and physiotherapy must:
  • Be prescribed by a qualified clinician
  • Demonstrate clear functional outcomes
  • Not duplicate or substitute recreational activities
• Claims that resemble structured lessons (e.g. swimming instruction) must not be funded unless:
  • Delivered as part of a clinically documented treatment plan
  • Supported by measurable therapeutic goals

Evidence-Based Funding Requirement

Legislation or Rules must require that:

All funded supports:

• Demonstrate a clear evidence base, OR

Submission 1784

• Show documented, measurable functional benefit to the participant

6.11 Restriction on High-Cost Recreational Programs

NDIS funding must not be used for:

• Recreational or lifestyle programs delivered at therapy-level pricing
• Activities that can reasonably be delivered by:
  • Support workers
  • Families
  • Community organisations

unless:

• A qualified clinician provides justification that:
  • The activity is necessary due to the participant’s disability; and
  • It cannot be delivered in a lower-cost, non-clinical setting

6.12 Prohibition on Reclassification of Activities as Therapy

Insert provision: “Activities that are recreational, social, or developmental in nature must not be classified or funded as therapeutic supports solely for the purpose of accessing higher funding rates.”

6.13 Program Accountability and Outcome Measurement

Providers delivering group programs or activity-based supports must:

• Define clear functional goals
• Measure and report participant outcomes
• Be subject to audit where:
  • Costs are significantly above standard support worker rates

6.14 Legal System Reform

• Default to paper-based determinations
• Mandatory internal review before litigation
• Limit legal expenditure

Submission 1784

6.15 Fraud Detection and Enforcement

• Real-time analytics to detect abnormal billing
• Payment suspension for flagged providers
• Financial recovery and banning powers
• Criminal referral for serious fraud

6.16 Participant Safeguards

• No liability for provider fraud unless complicit
• Ability to change providers easily
• Protection from service withdrawal during investigations

7. Outcome

These reforms will:

• Reduce fraud and overbilling
• Eliminate incentives for diagnostic inflation
• Restore fairness and consistency
• Protect funding for participants with genuine need

8. Final Position

The Scheme must draw a clear and enforceable line: NDIS funding is for disability—not for replacing ordinary parenting, household responsibilities, or recreational activities rebranded as therapy.

The NDIS must not become a marketplace where ordinary activities are repackaged as therapy and sold at inflated prices.

Disability support is not a business model—it is a public responsibility grounded in evidence, necessity, and fairness.

The NDIS is at risk not because it supports people with disability—but because it has become too easy to extract funding without sufficient accountability.

A system that:

• Rewards diagnosis over need

Submission 1784

• Allows providers to inflate billing
• Funds supports outside its intended scope

Will not remain sustainable. Reform must be decisive. Not broader. Not harsher. Sharper.

Because every dollar is lost to the system, gaming is a dollar taken from someone who genuinely needs support or is unable to access the scheme due to tightening eligibility.