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What is NDIS Fraud? How Can You Avoid It as a Participant or Provider?

What is NDIS Fraud? How Can You Avoid It as a Participant or Provider?

Dishonesty and fraud have eaten up about 20% of NDIS funds until now. In 2021, approximately $45 million of NDIS payments were cancelled as they were suspected to be fraudulent.

What is NDIS Fraud?

NDIS fraud occurs when someone tries to steal from the NDIS or unlawfully tries to get NDIS participant funds. While the NDIS fraud task force has played a critical role in investigating and prosecuting these crimes, some are identified only after they occur.

With these fraudulent activities, both the participants and the providers are hurt in one way or another. Some of these are:

  1. It makes it difficult to access the support participants require.
  2. It makes it hard to achieve participant’s goals.
  3. It puts unnecessary pressure on family, friends, and carers.
  4. Affects the quality of life.

According to the NDIS, some actions that qualify as fraud include:

  • Providing misleading information
  • Using fraudulent invoices and documents
  • Theft
  • Unlawfully procuring and using NDIS information
  • Misuse of funds
  • Falsely claiming travel or other entitlement
  • Making claims for services that are not provided

How To Avoid NDIS Fraud as a Participant

Though you may not be able to prevent fraud as a participant, there are several things you can do to protect yourself from the same. Some practices you can adopt include:

Check out the licensing of the provider

When checking on the licence, you want to see an insured, licensed, bonded provider. A trustable provider should have all the crucial qualifications which make them legitimate and able to provide NDIS services. Also, make sure they comply with the NDIS code of conduct and practice standards. To verify their credentials, visit the NDIA website to look them up or contact them.

Read provider reviews

Client testimonials and reviews are essential for evaluating a provider. This will help you make an informed decision and avoid what others have experienced with faulty providers. Ensure you check reviews from genuine sources before taking a call.

Ensure the provider is priced within the NDIS pricing arrangement

Please go through the NDIS price guide and understand how the price ranges are controlled for the services and support work of the NDIS. The regulations ensure that participants receive value for money for the kind of support they get. A legitimate NDIS provider will provide services only within the price limits set up in the NDIS price guide.

Ask to meet your intended provider in person

When it’s time to settle on your provider, consider visiting them at their designated office. This will help you see how they are in person, gauge how they vibe with you, and understand how they go about providing their services. Also, meeting them will help you understand their values and the virtues they stand for.

Consider the provider’s experience

Even if this seems like a minor consideration, looking for an experienced NDIS provider could help you avoid potential fraud. The NDIA is an observant and a sensitive organisation, and any provider committing fraud will simply not last for long. NDIS providers who have worked for some time with participants are well reviewed, safe, and reliable providers. Experience also means they are well established and will invariably offer quality services.

How to Avoid Being Accused of Fraud as a Service Provider?

Non-compliance is a term used when a provider does not follow the rules and regulations set by the NDIS. Being non-compliant can lead to fraud accusations or put you on the radar of NDIA. Some of the things to keep in mind to prevent being non-compliant include:

Follow the rules and regulations

You are unlikely to be accused of fraud by following the set rules. This is because the rules are set to prevent fraudulent activities with the NDIS funds.

Ensure to fill invoices correctly

As mentioned earlier, using false documents and invoices is considered fraud. As a provider, you must charge clients with the listed price limits set by the NDIS. Fill out all the documents and invoices ideally and without mistakes to ensure they comply with the NDIS.

Provide support worth what was paid

You must make a service agreement with your participants so that they know what to expect and the provider knows what they are expected to offer.

Keep proper records

The law requires all providers to have complete, accurate and verifiable records. This includes all the receipts, invoices, and documentation that highlight the services that you have provided. Proper records make it easy to counter any fraud claims with the NDIA.

What Is the Penalty for NDIS Fraud?

It is essential to know that the NDIA investigates all the cases of NDIS in partnership with the Australian federal police. NDIA, which has zero tolerance for fraud, prosecutes depending on the nature and severity of the crime. The punishment given can range from fines to serving a jail term.

Why is an NDIS Plan Manager Important?

As a participant, it can be overwhelming to manage your NDIS plan. Choosing an NDIS plan manager impacts the service you are offered and the items you can claim. Consecutively, with their connections with local providers, they can advise on the best service providers to choose to reduce the chances of fraud.

The NDIS Plan Manager will help you manage your fund and pay the providers on your behalf. This safeguards the claimable services and still ensures that the price limit set by the providers is correct. In the NDIS plan, a plan manager is the only trustable link between a participant, provider and the NDIS.

Conclusion

The NDIS expects all participants to act in accordance with all outlined guidelines. In case of fraudulent activity, the NDIS provides avenues to report anyone you suspect of conducting fraudulent activities.

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