Over two thirds of GPs think providers are abusing the NDIS to either a great (31%) or moderate extent (36%), a national Healthed poll of more than 1500 doctors has found. Only 11% thought no abuse was occurring.
Reflecting on their own caseload, 44% of GPs in the survey said they had at least one patient receiving NDIS benefits who was clearly abusing the system (of those, 7% said they had 10 or more patients who fit that bill).
Most GPs felt there was some amount of abuse by both patients (87%) and providers (89%), but twice as many GPs thought providers were ‘greatly’ abusing the NDIS (31%) than thought patients were (14%).
Many GPs blamed other providers for taking advantage of the system – and often taking advantage of their own patients.
GPs described providers inflating their fees for patients on the NDIS, or pushing services that patients don’t need – or in some cases billing for services they never delivered.
An impact analysis of the government’s proposed released in May cites the National Disability Insurance Agency’s estimate “that around 90% of plan management providers who service fewer than 100 participants show indicators of potential fraud or non-compliance.”
“Without changes, the plan management market would continue with some providers with unscrupulous and fraudulent motives, poor quality, variable services and capability, limited quality controls and weak mechanisms and conflicts of interest,” the analysis stated.
Roughly a quarter of the market consists of “small, low quality providers,” the report added.
The NDIS reform bill is now before parliament a final senate committee inquiry report expected in August.
Healthed’s poll suggests many GPs share some of the government’s concerns.
Around 600 GPs in Healthed’s survey identified the most common ways they see the NDIS being used inappropriately or abused – with most comments describing unscrupulous providers rather than patients.
“The majority of my NDIS patients are using the service appropriately and gain great benefit from the service. Most report at least 1 provider/ carer who has consistently provided poor care or behaved in a way to maximise their income inappropriately.”
Some GPs mentioned providers “ghost billing,” “phantom billing,” or “billing for services that were never delivered.” Some also described patients “exaggerating their symptoms” or “coercing the doctor to make their disabilities more complicated so that they can access more things.” However concerns about providers overcharging and over-servicing were more common.
“For patients, most misuse is low level and often driven by misunderstanding of eligibility, functional capacity requirements, or advice from third parties rather than deliberate intent. By providers there is more consistent evidence of inappropriate billing, over-servicing, and exploitation of plan flexibility by certain providers, particularly in psychosocial disability and behaviour support sectors,” one GP said.
To that end, three quarters of around 1500 GPs who answered a question about NDIS funding cuts worried their patients would be negatively impacted:
Overcharging was by far the most dominant qualitative theme – described in well over one third of responses – while around one in 10 mentioned providers over-servicing their clients.
GPs said patients on the NDIS were often charged more – with many describing the fees for that group of patients as “excessive,” and “exorbitant.”
One GP described a patient who was billed $4000 for paperwork for behaviour management, but did not receive actual on the ground support “because they spent all the money on the paperwork.
“Crazily inflated prices for both services and devices. I know that these are inflated for NDIS services, and much cheaper for people who do not claim these services or devices on the NDIS,” one GP observed.
“Patients are not abusing NDIS. It is the NDIS providers who seem to inflate the charges the minute they get a whiff of NDIS. Like wedding banquet becomes exorbitantly more expensive for the same food served if it was a birthday dinner or something,” another said.
Others noted that this inappropriate ‘inflation’ often seemed to go unchecked, and use of funds was not monitored. Likewise, some GPs said they had patients who were coerced or actively recruited by NDIS agencies despite still being independent and capable.
“Considerable overquoting and overcharging appears prevalent in providers some patients appear to be interpreting the benefits loosely.”
Equipment prices are higher when purchased by the NDIS than if the same product were to be purchased by the patient from an appropriate store
“I’ve been told by NDIS providers that they will charge triple the cost of what they would charge a non-NDIS client.”
“Once the provider knows it’s an NDIS plan, they charge at least $100 extra for the same exact service provided as private rate.”
GPs said some providers were encouraging unnecessary reassessments or reports, and in some cases providing services that the patients either didn’t need at all, or didn’t need as frequently as they were getting:
“I have a patient managed by their mother who weekly goes through invoices and finds invoices for things not delivered but billed for.”
“More often than not, my impressions have been the NDIS are using the patients to milk the system. Even though, the patients and carers admit the benefits of some services are minimal, they would not speak against the providers because they prefer to have some benefits rather than none.”
“A well-established diagnosis and prognosis… does not need an annual review at a cost of $3k to the package.”
“Multiple OT and/or physio assessments/reports that are expensive to obtain and contribute little in terms of advice.”
“In my experience, the most common concerns include over-servicing, claiming for services that are not clinically necessary, inflated pricing, duplicate billing, and claiming for services not actually delivered.”
“I seem to get a large number of detailed assessments (physio and OT) that are proforma, duplicates and often seem to contribute little to the wellbeing of support of the patient. In several cases have been repeatedly assessed.”
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