The cost of NDIS price cuts

Has it felt like keeping your business afloat gets harder every year? Well, unfortunately, you're not alone. Rising inflation, staff wages, insurance premiums, and even the cost of keeping the lights on and the car running, all adds up. And if you're in the business of supporting National Disability Insurance Scheme (NDIS) clients, the figures can look even tougher.

Add to that the growing admin burden of audits, compliance, and policy changes that shape your day-to-day, and the cost of care keeps growing.

But most people don’t choose this work for the money. They do it because they care deeply about improving lives – and we’re willing to bet you’re one of them.

Many providers go above and beyond, sometimes doing unpaid work just to keep the doors open and not let their clients down. That’s admirable, but it's definitely not sustainable. So, when the Australian Government recently announced price cuts to a number of NDIS services – including some therapies – it’s no surprise there was pushback.

You can read more about the rule changes that brought these cuts in here, but you’ve probably heard about the concerns from a number of peak bodies and providers across the sector anyway.

According to the National Disability Insurance Agency (NDIA), the latest round of price cuts has been geared in favour of participants and designed to keep the Scheme viable. The Agency says it’s all about tackling inflation and creating fairer and more equitable pricing that’s more in step with broader market rates.

But there's a major factor missing here – making it harder for providers to operate means fewer providers overall. That means less choice for participants, fewer options, and less control over the supports they need. And isn’t choice and control what the NDIS is supposed to be all about?

Pushback from across the NDIS sector

The Australian Physiotherapy Association (APA) has called for action from the Federal Government, saying recent price cuts to physiotherapy have stretched NDIS providers to breaking point. It says experienced clinicians are likely to exit the sector, reducing the availability of support for participants.

“We must act now to ensure the viability of our profession and protect the people we serve,” says the APA.

Occupational Therapy Australia reports the price freeze in its domain has left hundreds of occupational therapy businesses ‘on the brink of financial ruin’, with thousands of NDIS clients at risk of being left without care.

Meanwhile, the Australian Greens have called on the Federal Government and the NDIA to ‘engage in urgent and meaningful consultation with health professionals and disability support providers’.

Senator Jordon Steele-John, Australian Greens spokesperson for Disability Inclusion and the NDIS, says the pricing changes will affect the quality and accessibility of services for NDIS participants, and could result in professionals leaving the sector altogether and some provider organisations being forced to shut their doors.

Operating in the NDIS comes with different challenges

Teresa Wilkinson, a physiotherapist from Move For Life Therapy, says pricing in the Scheme hasn’t kept pace with growing operational costs or inflation.

“Wages, insurance, fuel, and equipment costs have all increased substantially, yet NDIS pricing has not adjusted accordingly,” says Ms Wilkinson. “This growing gap forces providers to operate on increasingly tight margins, risking service withdrawal and reduced availability for participants.”

Ms Wilkinson says providing NDIS supports carries unique obligations that aren’t present in mainstream healthcare, including compliance, high level communication, reporting, and travel – and for providers like mobile physiotherapists, these costs are significant and unavoidable.

“To provide quality care, we work closely with families, support coordinators, and health professionals, which is something less frequently done in a clinic setting, where care may be limited to a straightforward injury,” she says.

“Higher rates are not about overcharging but about reflecting the true cost of safe, compliant, and individualised service delivery. Communicating this transparently to participants and the NDIA helps maintain trust.”

What’s fair NDIS pricing anyway?

The NDIS Quality and Safeguards Commission says fair pricing means there’s no major difference between the cost of a product or service for an NDIS participant and the price applied to other customers. It says if a provider sets a higher price for NDIS participants and can’t justify the difference, they may be in breach of the Code of Conduct which now includes rules about price differentiation.

Providers say there’s sometimes a disconnect between rules and reality.

According to Ms Wilkinson, complex NDIS participants often require longer sessions, more provider travel, and additional reporting – all of which increase the cost to serve. She says higher price limits would make service delivery more sustainable and provider consultation is vital to ensuring NDIS pricing is realistic and fair.

“Lower prices will discourage provider registration and may lead to withdrawal of existing providers,” she says. “For small and mobile services, sustainability under the current price limits is increasingly difficult.”

“If more providers exit, participants will have fewer choices, longer wait times, and reduced access to essential supports. This will particularly affect participants in regional or outer-metro areas. For participants with mobility challenges or those living in regional areas, mobile physiotherapy (and other therapy providers) may become harder to access. Ultimately, this decreases the Scheme’s ability to provide choice and control.”

Ms Wilkinson says many providers have cut back on travel, limited their service areas, and reduced the time they spend on administration and reporting in order to absorb the price cuts and freezes and stay sustainable.

“While these measures may help businesses survive, they could come at the expense of quality participant care, flexibility and access,” she says.

“We continue to provide NDIS supports because we’re committed to helping people achieve their goals, maintain independence, and improve quality of life. Despite the challenges of the current pricing framework, we remain dedicated to participant outcomes.

“While we certainly need to work together to ensure cost efficiency, price reductions do not take into account the real costs of mobile service delivery. Lower prices may stretch participant budgets on paper, but if providers cannot sustainably deliver services at these rates, then access and quality will start to decline.

“Unfortunately, we’re starting to decline to see participants in certain locations that we would have previously covered before pricing changes.”

Sustainable NDIS pricing

Ms Wilkinsons says sustainable pricing in the NDIS isn’t about inflating costs, but instead about ensuring long term access, quality, and choice for participants.

“Recently, it seems there is a clear disconnect, with the NDIA prioritising cost control, the participants seeking quality and choice, and providers struggling with rising costs,” she says. “This can be addressed through genuine consultation, transparent cost reviews, and recognition of different service models.”

“Balancing affordability with sustainability is essential for the long-term success of the Scheme.”

The NDIA is clearly trying to make the Scheme more sustainable, and that’s something we absolutely support. It’s important the NDIS works long term for everyone involved, but sustainability needs to include the people delivering the supports too. This sector is one big ecosystem, and when one part struggles, it affects the whole thing.

Hopefully, future changes will take into account the voices of providers (people like you doing the work on the ground) and find a balance that keeps the Scheme strong and the sector thriving.

Friction-free NDIS claims

Providing safe, beneficial, and caring services to National Disability Insurance Scheme (NDIS) clients is going to be a top priority for any business in the disability sector, but equally important is getting paid. Because, let's face it, as amazing as your services are, you can’t keep delivering them without money coming in (ideally, on time!).

Like with any service, there can be friction points along the way that slow down payment or even stop it altogether. The good news is there's a lot you can do as an NDIS provider to dodge the potential pain points and keep your billing running smoothly.

At My Plan Manager, we check every invoice that comes in against a whole range of National Disability Insurance Agency (NDIA) rules and regulations, as well as Australian Taxation Office requirements, and our clients’ individual plans. This helps make sure everything’s in order before we submit claims to the NDIA for payment.

For more information – and to understand why we sometimes ask you questions about your claims – take a look at this article about the key checks we carry out on every invoice.

But it's not just about having the right information on your invoices, there are a few other things to keep in mind when supporting NDIS participants, things that can make the payment process even smoother.

And, as an added bonus, all these things don't just help your cashflow – they also strengthen your relationships with clients, reduce the risk of NDIA payment integrity audits (more on those here), and help build your reputation as a provider who’s ethical, reliable, and easy to work with.

Read on for our guide to friction-free NDIS claiming that will help keep you, your clients, and your bookkeeper happy.

Check that invoices are 100 per cent correct

Ok, we know we just said that invoices aren't everything, but they're still important enough to deserve the top spot, because even small mistakes on an invoice can delay a claim. If something’s not quite right, we’ll ask you to fix it, so it meets NDIA requirements. To make things easier, we’ve put together a simple guide to compliant invoicing that explains exactly what to include on your invoices to keep everything shipshape and moving smoothly.

Our sophisticated anti-fraud technology is the best in the sector and runs more than 30 automated checks on every claim to be sure the NDIA’s rules are met. Where a claim doesn’t look quite right, our team will flag where you need to correct it before we submit it to the Agency.

But not every NDIS participant has a plan manager or the benefit of this technology, and a small mistake can cause a claim to get held up with the NDIA’s prepayments team and even undo a funding request (when funding’s used faster due to error).

Check the item or service you intend to provide is consistent with your client’s budget

Check your client has the correct funding available in their NDIS plan to cover the cost of the supports you intend to provide and ask what funding periods are included, as these add rules to when a budget can be spent. This is particularly important where a client needs more frequent or longer supports up front – you need to make sure their funding period can accommodate that.

Getting granular and being clear about what item or service you intend to provide, as well as the frequency and cost – and checking that’s consistent with your client’s budget and funding periods –can make claiming more predictable. It's up to your client whether or not they're happy to share their plan with you, but a polite request for only the necessary section can go a long way.

Have a conversation up front with your client about their needs and spending and what it can mean for service provision

If you end up providing a service that's different from what you originally planned (based on your client's changing needs), make sure they understand what’s changing and how it might affect them.

For example, if you’re claiming from Assistance with Social and Community Participation under Core Supports, but the majority of those funds are being used to cover the cost of supports at home, make sure your client knows this can affect supports they can claim to participate in social and community activities (like joining clubs, volunteering, attending events or taking classes). This can prevent a surprise for them, or a disagreement down the track

Flag additional charges and how they can impact support hours

Transport charges can quickly add up, so if you’re planning an activity where you’re claiming transport and it’s a longer commute than usual, be sure your client understands this will reduce their total support hours, and that they’re involved in that decision. Explain the time and cost of transport to them.

The NDIA has clear rules about claiming for travel, and your client needs to agree in advance before you can charge for it. Our roadmap to NDIS travel and transport tells you everything you need to know about claiming travel in the NDIS.

Providers are expected to publish their prices and provide an explanation for how their fees are billed, which is usually included in a service agreement that both you and your client sign. Good providers will take the extra time to properly explain their fees and gain their client’s consent before extras like transport are charged.

Be vigilant about compliance

At My Plan Manager, we check claims against the Australian Taxation Office’s minimum invoicing requirements, the NDIA’s rules around compliance, and the NDIS Pricing Arrangements and Price Limits. We also review them against our clients’ individual NDIS plans, which have their own set of rules about what can be claimed.

As an NDIS provider, it’s important you have a good understanding of compliance yourself before booking a client in. Make sure the items or services you provide are something the NDIS actually covers (check that they’re they’re approved NDIS supports), because if they’re not, you might run into issues later and that can delay your payment or stop it altogether.

Claiming in the NDIS can be tricky but you’re not alone. If you have a question about a claim, we’re here to assist. You can email us at enquiries@myplanmanager.com.au or call us on 1800 861 272 from 8am-5.30pm (SA time), Monday to Friday.

What we check before an NDIS invoice gets paid – and why it matters

Managing claims and paying providers is a big part of what we do at My Plan Manager. We check the invoices that are sent to us, and if everything on them looks correct, we submit them to the National Disability Insurance Agency (NDIA). Then, once they’ve been approved and the NDIA has sent us the funds, we pay the invoices.

Claims in, money out. Simple, right?

Well, there’s a bit more to it. In fact, we go through quite a big checklist to make sure your claims are paid quickly and correctly, so you and your providers aren’t left hanging.

With the NDIA cracking down on fraud and non-compliance in the National Disability Insurance Scheme (NDIS), every claim is scrutinised. That’s why we scan each invoice with a fine-toothed comb to check it meets the Agency’s requirements before we send it their way.

Our anti-fraud technology is the best in the market, so when you submit an invoice to us, we run more than 30 automated checks on it to make sure it ticks all the NDIA’s boxes. If a claim doesn’t look quite right, our team will work with you and your providers to make sure it's correct before we submit it to the Agency.

To help you understand exactly what we look for – and why we sometimes ask you questions about the invoices you send us – here are the key checks we run to make sure your claims can be processed and paid as quickly as possible.

1. We check that invoices meet Australian Taxation Office requirements

The Australian Taxation Office’s minimum invoicing standards require tax invoices to include key information, like an Australian Business Number and a clear description of the goods or services provided.

This page on the NDIS website explains everything providers need to include on NDIS invoices and the records they have to keep.

Our article about payment integrity audits is also a useful resource for NDIS providers and their clients.

2. We check claims against the NDIS support lists

The NDIS support lists outline which services and supports can and can’t be funded by the Scheme.

Introduced in late 2024, the lists help everyone better understand what could possibly be funded through an NDIS plan. The rules also outline how people can request replacement supports in specific circumstances.

Before we process an invoice, we double-check it against the official list of NDIS supports. This helps make sure the support is something that's generally approved and is unlikely to be flagged as a concern by the NDIA.

3. We check claims against the NDIS Pricing Arrangements and Price Limits

The NDIS Pricing Arrangements and Price Limits (formerly known as the NDIS Price Guide) includes a support catalogue that outlines all the supports funded by the NDIA, as well as the maximum prices providers can charge for them.

In addition to price caps, the document includes helpful information like:

We check all these pricing rules against your invoice, because if they're not followed, the NDIA will send your claim straight back to us.

To simplify the NDIS Pricing Arrangements and Price Limits – a very complex document – and give a bit more information about how we check your claims, we’ve created this explainer.

4. We check claims against your NDIS plan

Every NDIS plan is different, which means your funding might work a little differently from someone else’s. How it’s set up and which support categories it includes, determines what you can use it for.

There are specific rules we need to follow when claiming payments, and those rules are based on how your plan is structured. Your plan could include things like stated supports, flexible supports, quoting requirements, and more… and, well, it can all get a bit complicated!

We recommend you work together with your providers to make sure they understand what’s funded in your plan. There’s nothing worse than starting a new service or placing an order, only to find your plan can’t actually cover it. This is where service agreements are a great idea to make sure everyone’s on the same page.

When we may ask for more information

There are times when we may request more information about a claim before we can process it. For example, where a support isn’t aligned with the funding in your plan, a letter of recommendation will likely be required by the NDIA. If the support is high-risk or complex, the Agency will usually want to see evidence that it’s safe to use, which can be provided in a letter of recommendation.

Sometimes it may be considered sufficient evidence if an allied health professional submits a high-risk assistive technology claim themselves – like a podiatrist claiming orthotics – because then it means the support is likely to be used safely. But it’s always best to check with us first.

Once a claim is submitted to the NDIA

When a claim is sent off to the NDIA, it’s put through the Agency’s many checks and scrutinised for compliance. Hopefully, all our checks mean it will quickly be given the tick of approval, and the funds will be released from your plan, so we can pay your provider.

If a claim is found to be not compliant, the NDIA will let us know, and we'll pass that information along to you.

Sometimes the Agency might tell us an invoice needs to be amended, and if that’s the case, we’ll touch base with you and your provider to make any changes that are needed, and then we’ll resubmit the invoice for payment.

Other times, the NDIA might request more information about a claim, like additional evidence that the support fits your needs. Again, we’ll let you know straight away so you can gather the information you need.

While waiting, the NDIA will keep the claim on hold – but once the right information is submitted and the claim is validated, it’ll be added to the Agency’s next payment run. The NDIA will notify us when to expect the funds, and we’ll let you know.

We’re here to help

If you have a question about claiming in the NDIS, we’re here to assist. You can email us at enquiries@myplanmanager.com.au or call us on 1800 861 272 from 8am-5.30pm (SA time), Monday to Friday.

Build your NDIS client list by creating meaningful support coordinator connections

In the world of the National Disability Insurance Scheme (NDIS), support coordinators play a huge role in connecting participants with the services they need to make the most of their plans, which is why so many providers focus on building strong connections with them.

It's a smart move for those trying to reach more clients – after all, support coordinators are key to helping participants find and access the right supports.

But let's be real… they're busy. With high caseloads and complex participant needs, support coordinators are constantly juggling priorities.

So, if you’ve ever felt like your emails or calls are being overlooked, you’re not alone and it’s not personal. It just means that reaching them takes a little more strategy, patience, and understanding.

In this article we’ve explored a few ways you can connect with support coordinators in a way that builds deeper trust and better communication, and that may ultimately lead to more collaboration. Because it’s not about leads, it’s about relationships.

First impressions count in the NDIS

If you're new to the NDIS space, you mightn’t realise how important communication etiquette is when it comes to networking. Support coordinators are there to support their clients, not grow your business, so diving straight in and asking for referrals without first building a relationship can easily backfire.

Instead, take a thoughtful and professional approach when introducing yourself and your service.

Here are a few tips to help you connect more effectively:

Building trust takes time, but with the right approach, you’ll be more likely to create meaningful connections that benefit both your service and the participants you support.

Be a connector and curator of useful information

You don’t have to be an expert to provide value. One of the easiest ways to establish yourself in the NDIS marketplace is by curating and sharing useful information that helps others save time and stay informed.

To do that, think about things like:

By making life easier for others, you build goodwill – and when people see you as a go-to resource, referrals will naturally follow.

Offer to help in small, practical ways

Networking with support coordinators isn’t just about shaking hands and swapping business cards – it’s about being useful.

Instead of approaching connections with ‘What can you do for me?’ consider ‘How can I help?’. Here are a few thought-starters:

Yes, offering help takes up your time and might not lead to immediate referrals. But building strong long-term connections is what really counts.

When a support coordinator sees you as someone who makes their job easier, adds value, and genuinely cares about participants, guess who they’re more likely to think of next time one of their clients or contacts needs a service like yours?

That kind of trust and reliability is what leads to lasting referral relationships.

Build credibility through conversations and visibility

Being visible in the NDIS doesn’t require years of experience, it requires showing up consistently and contributing to conversations. That can look like:

Consistency, curiosity, and a genuine willingness to help will always speak louder than a sales pitch.

Develop a small niche or special focus

One of the biggest mistakes new providers make is trying to serve everyone. Instead, find a specific area within the NDIS that you can become known for, whether that’s a particular type of support, a cultural/language-based approach, or working with a specific age group or disability type.

You don’t need to know everything, you just need to be useful and consistent in your chosen space. When people associate you with a particular niche, they’ll think of you first when a relevant opportunity arises.

Relationships come first, business follows

Referrals don’t happen overnight, and they don’t happen just because you have a service to offer. They happen because people trust you. And in the NDIS, support coordinators are often the ones guiding participants toward the services they need, so earning their trust is essential.

Start by giving first, sharing knowledge, resources, and connections, before expecting anything in return. Over time, as others recognise your reliability, generosity, and expertise, referrals will come naturally.

At My Plan Manager, we believe in building strong, respectful relationships across the NDIS community. Whether you're a provider or a support coordinator, we're here to support connection, collaboration, and better outcomes for everyone. And if you come across our team at an expo or event, drop by and say hi!

10 ways to keep your NDIS plan on track without a support coordinator

Support coordinators can be a guiding force in the National Disability Insurance Scheme (NDIS). They’re there to help make your journey smoother by setting up supports, offering advice, and navigating the ever-changing rules so you can get the most out of your plan and reach your goals.

But the reality is, not everyone will have support coordination funded in their NDIS plan. And honestly, that’s totally okay.

Many people have the capacity to manage their plan themselves – and not just get by but thrive. With the right tools, a bit of preparation, and support from other sources, you can absolutely take charge of your NDIS journey. There are ways to build your own skills and knowledge, and plenty of people and resources out there to back you up when you need it.

It might feel a little daunting at first, but trust yourself, you’ve got this. Before long, you’ll be feeling like your very own support coordinator.

So, here are 10 practical ways to keep your NDIS plan on track, even without support coordination funding.

1. Become your own self advocate

Understanding the ins and outs of the NDIS, knowing your rights and where to seek help, communicating your needs, building a strong support network, and being actively involved in the planning and reassessment of your NDIS plan (by gathering evidence and setting up goals) can ensure your voice is heard and you receive the funding you need.

At My Plan Manager, we have a collection of informative articles from effective goal setting to the role of letters of recommendation to help you move forward in the Scheme. The NDIS Pricing Arrangements and Price Limits sets out what pricing providers can charge so you can find competitive pricing and make sure you’re receiving value for money, and we’ve created this simple explainer to help you do that too.

Click here to browse our full library of articles.

You can also sign up for NDIS news alerts, and the National Disability Insurance Agency (NDIA) regularly holds online and in-person events where you can brush up on your NDIS knowledge to better understand different aspects of the Scheme. Each step you take builds your skills and confidence to advocate for your own needs and wants.

A number of organisations also hold live workshops and webinars or provide online courses too – some free and some paid – but be sure to check their credentials first. They can teach you the basics of the NDIS, how to manage your plan, how to budget your funds, how to understand your rights, and how to communicate effectively with providers.

You may be able to use some of your NDIS funding to attend paid training. If you’re unsure if you have the correct funding in your plan, contact us or ask the NDIA to check.

2. Understand your individual NDIS plan

Everybody's NDIS plan is different, so it's important you understand what's included in yours, and what supports it might fund.

Your plan includes information about your disability, goals, and the reasonable and necessary supports funded by the NDIS – broken down into Core Supports, Capacity Building Supports and Capital Support budgets – with specific rules about how to use your plan and your funding.

The NDIA’s created this web page about understanding your plan which breaks down the inclusions and what to know, and it provides these handy booklets and fact sheets about using your plan, changing it, and managing your funding.

It's also a good idea to request a plan implementation meeting with your NDIA planner whenever you get a new plan. Because whether it’s your first, second, or fifth NDIS plan, each one is a little different, and your planner can take you through it line by line.

3. Know where to locate providers

Support coordinators serve as crucial intermediaries in the NDIS by helping their clients to understand what their plan can fund, then helping them identify suitable providers who can offer those items and services. Once you understand what’s covered by your plan and who can provide it, it’s time to choose the providers you want to work with.

There’s a wide array of options when seeking providers – including provider directories, social media groups, and word of mouth referrals. The key is looking for people you get on with, and who have the skills and experience to provide the supports that you need. Clickability, Disability Support Guide, Karista, and My Care Space are just a few of the free online directories where you can search for NDIS providers, both registered and unregistered. You can choose the type of service or product you’re looking for and add in your postcode to see providers offering supports in your local area.

Hireup, Mable and Mobility are platforms where you can hire and manage your own support workers – the trick is to be specific about exactly who and what you’re looking for.

For many people, the best place to start is by talking to their community – including existing supports like their doctor or physiotherapist, or school staff, friends and family.

Remember, when searching providers in the NDIS, you have the right to ask questions and shop around to make informed choices.

4. Get family upskilled

If you have family members who assist you, consider getting them trained on how to manage NDIS-related tasks, of course in addition to you understanding them yourself! This can empower them to support you more effectively and ensure that everyone’s on the same page.

For example, your family members could learn how to manage your appointments by speaking with your providers and understanding the details in your plan by referring to the handy tools provided by the Agency, including its booklets and fact sheets.

5. Use a plan manager

While support coordinators help participants to implement their plans and connect them to providers, plan managers (like us) support participants to manage the funding in their NDIS plans.

That means the NDIS pays for our services and we work with you to process your invoices, manage and track your budget, deal with your providers, speak with the NDIA about your claims, and answer questions about the Scheme.

Working with a trusted plan manager is the fastest way to free up more time and have NDIS knowledge in your corner – which you can call upon from us whenever you get stuck. Not sure what your plan can fund? Want to know what evidence is needed when you request funding? We’re here to guide you every step of the way.

6. Using regular support hours

Did you know you can use some of your regular support hours to get help with NDIS-related tasks? This could include having a support worker help fill out forms, make phone calls or organise your schedule. It’s especially helpful if paperwork is daunting to you or if you need help to keep on track. Simply let them know where you’d like them to assist.

7. Tips from providers

Your occupational therapist or other allied health providers might be able to offer valuable tips on managing your NDIS plan. They might show you how to organise your supports more effectively or suggest tools that can help you stay on top of your plan. For instance, they could teach you how to use a planner to keep track of your appointments and tasks.

8. Support groups

Joining a support group can be incredibly beneficial. You can share experiences, learn from others facing similar challenges, and get emotional support. It’s a great way to bounce ideas off others and see what’s worked for different people.

There are plenty of in-person and online support groups, many run by disability-specific organisations, or through local carer networks. Ask your service providers if they’ve heard of any groups locally that might interest you too – often they’ll hear things from other clients.

Social media groups about the NDIS can also be a great place to ask questions and connect with others – just make sure you verify any answers with another trusted source.

9. Advocacy services

There are free advocacy services available to help you understand your rights and support you in dealing with the NDIA. These services can provide advice, represent you in meetings, and help resolve issues. For instance, if you’re having trouble getting the supports you need, an advocate can step in and help you make your case.

To search for an advocacy organisation near you, Ask Izzy is a great tool.

10. Apps and online tools

There are some great apps out there to help you manage your NDIS plan. Our client portal (web and app) provides a snapshot of your budget in real time, and lets you track spending down to the cent, submit invoices and claims for reimbursement, receive alerts when payments are processed, and more. If you self manage your funding, the NDIS has its own app, the My NDIS mobile app.

There are also apps and online tools that can help you keep track of different aspects of your support, such as appointments, paperwork and key dates in your plan.

If in doubt, contact the NDIA

The NDIA is the government agency that runs the NDIS, and it can help answer questions, explain rules, and point you in the right direction. You can reach out to the NDIA by calling 1800 800 110, visiting a local NDIS office, or using the contact options on the NDIS website.

Remember, you’re never alone in the NDIS. There are plenty of ways to grow your skills, build confidence, and take more control of your NDIS plan. Help is available – you may just need to seek it out. And if you ever have questions, don’t hesitate to reach out to us. We’re here to help.

How to spot red flag behaviour in the NDIS

National Disability Insurance Scheme (NDIS) providers have a duty of care to deliver services safely and competently, and an obligation to protect you from harm, abuse, neglect, and exploitation. These requirements are backed by important laws that help protect your rights and keep the disability community safe.

The NDIS Code of Conduct outlines the expected behaviours of all providers and workers in the Scheme, and the NDIS Practice Standards set the quality benchmarks that must be met by those who are NDIS registered.

We know most providers work hard to treat their clients ethically, fairly, and honestly – and that’s important to remember, because positive client-provider relationships that are grounded in mutual respect deliver better outcomes for everyone.

But although most people working in and around the Scheme are doing the right thing, some aren’t, and that’s why it’s important to be vigilant.

Red flags are warning signs that can indicate dishonest or unethical behaviour and being able to spot them can help you protect your rights, make informed choices about the providers you work with, and get the high-quality services and supports you deserve. We’ve pulled together a list of seven red flag behaviours to look out for in the NDIS.

1. Not explaining charges

Providers are expected to publish their prices and provide an explanation for how their fees are billed. This is information which is usually included in a service agreement that both you and they sign. Good providers will take the time to properly explain their fees and gain your consent, and they should make sure the services they deliver are covered in your NDIS plan.

Under NDIS rules, registered providers can’t charge gap fees or credit card surcharges – and if they do, you should report them to the NDIS Quality and Safeguards Commission.

When providers submit an invoice, they must also adhere to the NDIS Pricing Arrangements and Price Limits and the Australian Taxation Office requirements, and their invoices should include clear descriptions broken down by hours and service dates.

If a provider charges you without your advance consent or their charges aren’t clear, ask them to explain them to you. If they’re hesitant to do that, that’s a red flag.

If you have a plan manager (like us!) they can help you talk to your providers about invoicing.

2. Overservicing

Recommending an assessment, report, or service that’s unnecessary for you, for the purpose of their own financial gain is a big red flag.

If a provider recommends a report that doesn’t sit right with you, ask them to explain how it’ll help you. If they can’t or it doesn’t make sense, you have every right to seek a second opinion, and if you have a support coordinator, you can also ask them.

Providers suggesting services that don't align with your NDIS plan or delivering supports at a price that doesn’t adhere to the NDIS Pricing Arrangements and Price Limits, can raise concerns – but it’s important you first check to see that they haven’t made a simple mistake.

At My Plan Manager, we check that your funding is used correctly, and that you’re charged the right amount for services and items that are funded in your NDIS plan. To do that we’ve invested in robust, client-focused technology that automatically conducts payment integrity checks. Every claim we receive undergoes more than 30 automated checks to ensure it’s compliant with the National Disability Insurance Agency’s (NDIA) requirements.

3. Charging for travel that doesn’t occur or adding unnecessary travel time charges

The NDIA has clear rules about claiming for travel, and as a participant, your advance agreement is required before your providers can charge you.

If a provider invoices you for travel that didn’t occur, or if they’ve added unnecessary travel charges to an invoice, be sure to ask them to explain.

Our roadmap to NDIS travel and transport tells you everything you need to know, and you can also find information from the NDIA on this web page.

4. Unfair pricing

Unethical provider behaviour includes price differentiation – which is where NDIS participants are charged more than those who aren’t in the Scheme, without any justification.

If you’re charged an inflated price simply because you’re an NDIS participant, that’s a red flag.

According to the NDIS Quality Safeguards and Commission, fair pricing is when there’s no major price difference between the cost of a product or service for an NDIS participant and another customer, and, if a provider sets a higher price for NDIS participants and can’t justify the price difference, they may be in breach of the NDIS Code of Conduct, which includes rules about price differentiation.

5. Conflicts of interest

A conflict of interest occurs when a provider’s personal interests clash with their responsibility to act in your best interests. That could look like referring you to a partner organisation to gain payment, gifts, or additional business, even when it mightn’t be the best option for you.

It's fine for providers to recommend services that suit you, but if they do it strictly for their own gain, that’s unethical.

Under the NDIS Code of Conduct, all NDIS providers must act with integrity, honesty and transparency, and disclose any real, perceived, or potential conflicts of interest when offering and providing supports. That means if they have a personal stake in recommending a service, they have to let you know.

Providers must be transparent when offering supports and services delivered by their own organisation and they need to offer alternative options outside of their business so you can make an informed decision.

The NDIS Practice Standards set out what NDIS registered providers are required to do to avoid conflicts of interest, and the NDIS Quality and Safeguards Commission can take action against a provider if those obligations aren’t met.

It can be hard to spot potential conflicts, but asking your provider why they believe a recommendation they’ve made is the best option for you can help.

6. Coercion

Coercion can occur when a person uses controlling behaviour to force you into actions you don't want to take.

People who use threats or manipulation – like telling you they’ll stop services or report you to the NDIA, police, or immigration – to control you or to keep you from speaking up is a red flag and must be reported to the NDIS Quality and Safeguards Commission.

If you believe you’re in immediate danger you should contact the police on 000.

7. Breaching your privacy

If anyone asks to see your devices – like your phone, computer, or tablet – it’s a concern. It’s probably ok if they’re assisting you with something on a screen, but they shouldn’t need to take your device away from you.

Access to your technology means they could see or change private information (e.g. your bank account details or passwords).

Trusted providers should never ask for your log in codes or passwords, and it would likely be a breach of the terms and conditions of your relationship with them if they had access to such information, because it could expose you to identity theft or fraud.

Keep alert and speak up

These red flags can help you ask the right questions and make more informed choices about the providers you work with. Genuine mistakes can be made and not every red flag means unethical or dishonest practices have occurred, but they can remind you to stay alert.

If you have any concerns, your first step should be to talk with your provider directly. You have the right to feel safe when raising concerns, but if you need to, you can ask a trusted person to help you with it.

Every NDIS provider must have a complaints policy and a way for clients to raise concerns, and if you’re not happy with how the provider manages things, you can notify the NDIS Quality and Safeguards Commission as well.

If in doubt, look to the NDIS Code of Conduct

Take time to understand the NDIS Code of Conduct and the NDIS Practice Standards. These resources help you know what quality service looks like and what you should expect from NDIS registered providers.

And remember, the NDIS is full of providers doing everything they can to deliver great supports to their clients. Here’s a quick list of green flags that signal an NDIS provider is ethical, fair, and transparent.

  1. They respect your right to shop around and make informed choices.
  2. They help you make decisions for yourself, rather than making them for you.
  3. They assist you in managing your own affairs, instead of taking over.
  4. They support your preferred ways of communication, not speaking for you.
  5. They allow you to independently access your devices and personal information, stepping in only when needed and when asked to by you.
  6. They respect and safeguard your privacy.