For the past two years, the NDIA has been driving the narrative that fraud is rife within the scheme, with funds being spent on items or services that aren’t NDIS supports or included in a participant’s NDIS plan.
The NDIA has subsequently created a fraud taskforce and introduced a supports list to try to resolve this issue. But in some instances, the NDIA is even raising debt to reclaim funds spent on what it deems non-compliant supports.
Without a doubt–and we need to emphasise this–the majority of providers are doing the right thing, but the NDIA might still raise a debt against you for errors in claiming, as your business gets swept up in the broader fraud crackdown.
Within this post, we want to explore what you need to do to remain compliant, ensuring the funds you’re claiming are clearly listed in a participant’s plan. It’s all about best practice.
Why are debts raised?
The NDIA might raise a debt against you if NDIS funds are incorrectly claimed or misused. This could happen for a variety of reasons, with section 46 of the NDIA Act outlining specific situations for you to consider:
- Claiming for supports that aren’t funded in a participant’s NDIS plan
- Making mistakes in claiming, like accidentally claiming for something no longer on the NDIS supports list or for a shift that didn’t happen
- Providing false or altered evidence such as fake invoices.
Both of the first two reasons might happen accidentally, as a result of inaccurate record keeping or genuine human error without any intent. But accidental or not, debt can still be raised against you.
If you notice an error and cancel a claim after funds have been paid to you, the NDIA will raise a debt. More commonly, however, they will initiate the process because they’ve identified an error in a post-payment review.
The debt raising process is complemented by Payment Integrity Audits (PIA), which are checks that take place prior to a claim being paid. We wrote about PIAs in a previous blog post, which you can read here.
What should you do if debt is raised?
If you initiate debt after cancelling a claim or the NDIA initiates after flagging an error, the NDIA will contact you to seek clarification and ask for evidence related to the claim. If the NDIA proceeds, you will be issued a debt decision letter, which explains the process to you, including payment options.
Please note that there is no provision under the NDIS Act to appeal the NDIA’s decision to raise a debt, but you can contact the NDIA on schemedebtmanagementteam@ndis.gov.au to ask them to revoke the decision or waive the debt if:
- it’s due to an error
- it’s a small debt
- the issue has been settled
- there are special circumstances.
The NDIA explicitly states that a waiver cannot occur where a false or misleading statement has been made to the agency or a provider has failed to comply with the Act or the scheme’s regulations and rules.
Interestingly, the NDIA just completed a review into its debt raising practices and has agreed to repay some money to participants and providers, offering a formal apology. You can read more here.
What’s best practice for compliance?
In the majority of cases, debt will be raised because a claim is incorrect or has been submitted in error, presumably for a service no longer ‘in’ the NDIS supports list or that isn’t compliant with a participant’s plan.
Although there’s scope to appeal, as described above, the priority should be to ensure claims comply with the the supports list and records are accurate and up-to-date, so that claims are without error when submitted.
This includes:
- Integrating your CRM/CMS and finance systems so there’s no errors in claiming, with your system communicating with each for consistency.
- Understanding the supports list and ensuring what you claim aligns with the participant’s NDIS plan. This includes seeking consent from the participant to see their goals and noting this within your CRM/CMS.
- Utilising a suitable reconciliation process for rejected claims, so that you can easily resolve rejected claims.
At quickclaim, our billing solution can support you in achieving compliance, so that you can manage your claims in one place.
