At the February Senate Estimates I asked the National Disability Insurance Agency (NDIA) how much money has the NDIA been able to claw back through identified National Disability Insurance Scheme (NDIS) fraud? Funding across 16 agencies, including the NDIA, of $140 million over four years was provided in 2022 to tackle fraud. Those agencies are working together. It seems reasonable that we should know what return on this investment we’re getting since we’re paying for it.
There are major concerns with the NDIS. It was hastily brought to life and hastily implemented. There are concerns with both over and under-servicing. That’s not necessarily a reflection on the people in the NDIA, but that’s the reality.
I also asked what is being done in relation to auditing service providers who are sucking the scheme dry through fraudulent claims for services that are overcharged or actually not even provided? My questions regarding the amount actually clawed back was taken on notice, however John Dardo, Deputy CEO of Integrity Transformation and Fraud Fusion Taskforce, freely admits to having layers of concern about NDIS fraud. There are over 600,000 participants in the scheme and Mr Dardo says the system is extraordinarily immature for a scheme paying out over $100 million each day, with 400,000 claims a day. Among the risks they’re managing is whether they can be confident that a participant is a real human being, is in the scheme knowingly and actually exists.
Transcript
Senator ROBERTS: Thank you for appearing today. On the topic of fraud, how much money has the NDIA been able to claw back through identified NDI fraud?
Ms Falkingham: I’ll ask Deputy CEO John Dardo, who leads that program, to come forward to the table.
Mr Dardo: Thanks for the question. There are different ways to measure that. One of the ways to measure it is to think about how much we’ve prevented from going out the door by implementing systems or detecting the integrity leak before the money has left the door. Another way to measure it is to look at whether we’ve asked the participant or provider to pay the money back. Another way to measure it is by the amount of money that is subject to a prosecution activity—so where it has gone to the courts. Not all of that is recoverable, because unless there’s criminal asset confiscation, or unless there are penalties being charged, that money may not be recoverable. So there are lots of different ways to measure it.
What I would say is that, as my colleague mentioned earlier in relation to detecting the anomalies, there are a range of things that we’ve been building up over the last 18 months to allow us to identify where there are integrity leaks, and what I would emphasise is that integrity leaks are very, very strongly correlated to participant risk. The safety of participants is put at risk when money is leaking to the wrong places. It’s because the participants aren’t receiving the services they need, or because we’ve got providers that are dodgy and are actually growing their businesses at the expense of good providers—so they’re wiping out the good providers—or because that money is actually funding activity for participants that is putting them at further risk, whether it be drug abuse, alcohol abuse, risky behaviours or other behaviours. So the money’s important, but the reason we look at the money is the participant safety impact that it has.
What I would also say is that there’s a level of detail that I can’t share in this forum—I’m happy to do it in a private setting—because we do not want to run a 101 session on how to commit fraud against the NDIA. But I’m on the public record in previous hearings talking about the layers of concern that we have. We have, in round figures, over 600,000 participants in the scheme. The system is extraordinary immature for a system that pays out over $100 million a day, with 400,000 claims a day. It is an extraordinarily immature system. Certainly it’s one of the most immature I’ve seen. If I think about the sorts of risks that we’re managing and investing in, being confident that a participant is a real human being, is in the scheme knowingly and—
Senator ROBERTS: Actually exists.
Mr Dardo: actually exists is an area of risk that we’re certainly unpacking and understanding, and we’re identifying things that need to be addressed.
Senator ROBERTS: Excuse me. Out of respect for the chair wanting to conclude pretty soon, could you take it on notice to provide the figures around the categories of fraud that you mentioned earlier on, please? What money has been saved?
Mr Dardo: We can do that.
Senator ROBERTS: There are concerns with the NDIS. It was hastily brought to life. It was hastily implemented. There are concerns with overservicing, as you know. There are concerns with underservicing and there are concerns with fraud. That’s not necessarily a reflection on the people in the NDIA at the moment, but that’s the reality. Please also take it on notice to answer: what is being done in relation to auditing service providers who are sucking the scheme dry through fraudulent claims for services that are overcharged or actually not even provided?
Mr Dardo: An enormous amount of activity. Some of that activity is some randomised integrity checks. We’ve done tens of thousands of those to try and understand, at a randomised level, what we’re seeing. The sorts of common things we’re seeing include overclaiming, duplicate claims, claiming for services that were never provided and claiming for services that are not consistent with the plan. If I think about some other risk points, we have some particular cohorts where we have very significant concerns about the behaviour of the cohorts, and, when we cross-reference our data with other data such as tax data, for example, we see that some of our providers are non-compliant with basic obligations to the Commonwealth. If they’re non-compliant with their basic obligations to the Commonwealth but they’re managing money on behalf of participants or managing services on behalf of participants, we’ve got concerns. We have several hundred providers where they’re managing money or services on behalf of participants or managing other providers on behalf of participants and yet they’re not compliant with their most basic tax obligations. We’re cross-referencing data with other agencies.
A taskforce commenced in November 2022. At the most egregious end of the offending, that taskforce has 16 Commonwealth agencies working together to identify networks of providers or syndicates that are targeting the scheme. You may have seen some media coverage about the search warrants being executed, the prosecutions being conducted and passports being seized or surrendered as part of bail conditions. That work is continuing to ramp up. We have over 100 investigations in the pipeline, and some of those cases are very significant both in dollar value and participant numbers being affected and also in the egregious behaviour of those providers.
Senator ROBERTS: There are a lot of costs involved. Some of the costs are from the 16 agencies that are working with you and they’ll be hidden from the total cost.
Mr Dardo: No, those agencies were funded as part of that announcement. That funding was $140 million over four years. Those agencies, as well as the NDIA, were funded as part of that Fraud Fusion Taskforce and they’re working in partnership with us.
Senator ROBERTS: Thank you.
Having had a long association with support for people with disability I have concerns about the potential misuse of NDIS funds, My understanding is the evidence indicates such poor management and lack of expertise at delivery points is seeing one client suffering funds removed to subsidise another where overspending has occurred. It seems that inexperienced people are in charge of this very complex process and major anomalies appear to be being covered up.