DOCUMENT 1
FOI 20/21-0676
Our Reference: Response to FOI 20/21-0676
FOI 20/21-0676 – Information on participant fraud from 1 January 2019 to 1 January
2020, data as at April 2021
Scope
1. The number of reports of fraud against participants between Jan 1st
2019 to Jan 1st 2020
2. The number of the above reports investigated.
3. The number of those investigations that found fraud.
4. The reasons of the above investigations found to be fraudulent.
5. The amount of money found to be fraudulently used by participants
during the same time period.
6. The number of random audits of participants conducted during the
above time period.
7. The number of those audits that revealed fraud
8. The amount of money of that fraud
9. The reasons that the money was found to be used fraudulently.
10. The numbers that have had self management [sic] revoked due to
fraud during the above time period.
11. The numbers of alledged [sic] fraud actions in that time period that
were appealed 12. The results of the appeals.
Response
1. The number of reports of fraud against participants between Jan 1st 2019 to Jan
1st 2020:
The NDIA has a dedicated telephone line and email in place (Fraud Reporting & Scams
Helpline) where suspected non-compliance or Fraud against the NDIS can be reported.
The NDIA recorded 1,066 tip-offs where the participant was the primary subject during
this period.
2. The number of the above reports investigated.
Al reports received through the Fraud Reporting & Scams Helpline are taken seriously.
Al allegations received are assessed to determine the most appropriate course of action.
Sometimes the information provided relates to the responsibilities of the NDIS Quality
and Safeguards Commission and where appropriate these allegations are sent to them
for their consideration.
To support fraud prevention the NDIA has developed the Compliance and Enforcement
Framework (the Framework). The Framework is intended to provide an overview of
compliance and enforcement options, as well as provide information on when the use of
each option is appropriate.
These options may include one or more of the following compliance activities; targeted
engagement (the Agency’s first response when addressing inadvertent non-compliance),
a desktop compliance review (used to address opportunistic non-compliance) or a fraud
investigation (to address deliberate fraud with a criminal intent).
Of the 1,066 tip offs received about participants, nil have resulted in a fraud investigation.
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FOI 20/21-0676
Our Reference: Response to FOI 20/21-0676
3. The number of those investigations that found fraud.
None of the above recorded 1,066 tip-offs proceeded to fraud investigations during this
period. However, other compliance actions may have been undertaken.
While none of these tip-offs proceeded to a fraud investigation during this period, they
may stil be sit ing as an open matter that may proceed to a fraud investigation at some
point in time.
4. The reasons of the above investigations found to be fraudulent.
This is not applicable, see response to point 3.
5. The amount of money found to be fraudulently used by participants during the
same time period.
This is not applicable, see response to point 3.
6. The number of random audits of participants conducted during the above time
period.
The Agency undertakes quarterly random audits of participants who self-manage their
plans. A total of 203 audits of participants were conducted during this period.
7. The number of those audits that revealed fraud
Nil.
The Agency defines fraud to be ‘dishonestly obtaining a benefit, or causing a loss by
deception or other means’. Identification of deliberate intent to receive a benefit, such as
theft or the provision of false invoices, which is more than carelessness, accident or
error, triggers the referral of a matter for fraud investigation.
8. The amount of money of that fraud
This is not applicable, see response to point 7.
9. The reasons that the money was found to be used fraudulently.
This is not applicable, see response to point 7.
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FOI 20/21-0676
Our Reference: Response to FOI 20/21-0676
10. The numbers that have had self management [sic] revoked due to fraud during the
above time period.
Nil.
Unless a participant is found not to have satisfied the eligibility criteria for access to the
Scheme, access would not be revoked.
The Agency can consider whether it is appropriate for a participant to continue to self-
manage their plan. Responsibilities of self-management include: managing your funding;
keeping records of invoices and receipts; showing how you have used your self-
managed funding towards reaching your goals at your plan review and participating in
payment auditing where you wil need to provide invoices, receipts or other evidence to
show that you have spent your funding in-line with your NDIS plan.
11. The numbers of alledged [sic] fraud actions in that time period that were appealed
This is not applicable, see response to point 10.
12. The results of the appeals.
This is not applicable, see response to point 10.
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