On this page:
- Provider compliance letters
- What appears unusual about these payments?
- What claims are you monitoring?
- Where to go for more information
The NDIS is carefully monitored to make sure participants get the supports they need and providers are paid correctly.
From August 2021, the Compliance Response Team (CRT) are reviewing claims for payment that appear unusual or incorrect in the context of the NDIS Pricing Arrangements and Price Limits and participants’ plans.
If your organisation has submitted one or more claims for payment that appear unusual or incorrect, you may receive a compliance letter from the CRT.
If you get a provider compliance letter, we would like you to review these payments and confirm they are correct. Read the letter fully to understand what it’s asking you to do.
CRT actively monitors claims for payment by providers, plan managers and self-managed participants.
Payments might appear unusual if:
- they appear incompatible with the NDIS Pricing Arrangements and Price Limits
- one or more elements of the claim vary significantly from claims for like supports from comparable providers.
There are different reasons that payments can be flagged for a compliance review, and some of these reasons may be valid.
We are asking you to review these claims and confirm whether they have resulted in participants being overcharged.
CRT are currently monitoring payments that include one or more of the following factors :
- weekend supports that appear to have been delivered on a weekday
- an unusually high volume of supports claimed against participants plans
- services claimed at the same time as short-term accommodation that are potentially incompatible
- charging plan management financial administration fees incompatible with the claiming rules set out in the NDIS Pricing Arrangements and Price Limits
- charging an unusually high volume of support items compared with providers and/or plan managers who support participants with similar needs.
Please note, this list is not exhaustive.