NDIS Providers: Mastering Compliance And Dispute Resolution

The National Disability Insurance Scheme (NDIS) has changed how Australia provides disability support services. However, NDIS providers now face more checks from regulators and could face large fines if they do not comply. This stricter environment is causing more disputes between providers and regulators, as well as between providers and participants. This article looks at:

• common disputes;
• regulatory risks; and 
• ways you can protect yourself as an NDIS provider.

NDIS Providers Should Prepare for Regulatory Investigation

The NDIS operates under complex laws, which can be challenging for providers. Understanding these laws is crucial for following the rules and solving disputes. Providers need to know their responsibilities under:

• The  NDIS Act 2013 (Cth): The main law that governs how the scheme works.
• NDIS Rules: Additional regulations that give detailed guidance on supports and specialist disability accommodation (SDA).
• NDIA Operational Guidelines: Internal policies that guide NDIA staff decisions.
• The Privacy Act 1988 (Cth).

In late 2024, the Minister for the National Disability Insurance Scheme announced stronger efforts to prevent fraud and enforce rules. The message is clear: not following the rules is unacceptable. A recent court case resulted in a record $1.9 million fine for an NDIS provider. This shows the serious legal and financial risks of not following the rules. It also highlights that NDIS providers must strictly follow all regulatory requirements to avoid severe consequences, including:

• large fines; and 
• potential personal responsibility for those in charge.

As a provider, you should be ready for more audits and investigations and consider getting professional legal advice to ensure that you are following all current regulations.

Key Areas of Regulatory Focus

The NDIS Commission sets and communicates its Regulatory Priorities for each financial year. For 2024-25, these priorities are:

• reducing and eliminating the use of restrictive practices on participants by closely monitoring how behaviour support plans are created and implemented;
• ensuring registered NDIS providers follow their registration conditions, especially auditing requirements, effective incident management systems and  reporting obligations;
• ensuring safe and competent delivery of supports and services by registered and unregistered NDIS providers and workers, especially in supported accommodation settings;
• regulating the conduct of registered and unregistered NDIS providers regarding individual participant rights, independence and choice and control; and
• preventing and removing dishonest providers and workers from the NDIS, focusing on pricing, false and misleading conduct and serious and organised crime.

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How Increased Scrutiny Leads to Disputes

We have seen an increase in disputes between providers, regulators and participants. This rise in conflicts is due to several connected factors, including the following:

• the complex and changing nature of NDIS regulations often leads to disagreements over how to interpret and apply the rules;
• there are more regulatory audits and investigations, leading to disputes over findings and required improvements;
• ore public discussion about regulatory action has made participants more aware of their rights and provider obligations, potentially leading to more complaints; and
• financial pressures from stricter compliance requirements can create tension between making a profit and following regulations, especially for small businesses.

Reducing Risks and Resolving Disputes

To handle these challenges, NDIS providers should, at a minimum:

• put in place strong compliance programs that align with NDIS legislation and rules;
• ensure that they have a set of robust policies relevant to their business and the support they provide;
• regularly check their internal processes;
• provide ongoing staff training on NDIS requirements; and
• seek legal advice when unsure about their obligations.

Key Takeaways

NDIS providers must strengthen compliance efforts to navigate increasing regulatory scrutiny and avoid hefty fines or personal liability. This includes ensuring strict adherence to legislation such as the NDIS Act 2013 and NDIS Rules. As a provider, you should focus on reducing restrictive practices, maintaining effective incident management systems and safeguarding participant rights. With more audits and disputes on the rise, providers must:

• implement robust compliance programs;
• regularly review internal processes; 
• maintain thorough records;
• train staff on regulatory requirements; and 
• seek legal advice when needed. 

Frequently Asked Questions

What should I do if I receive a compliance notice or regulatory investigation?

You should act quickly by reviewing the notice carefully, gathering all relevant documentation and seeking legal advice to ensure you respond appropriately. Engaging with regulators cooperatively and transparently can help mitigate risks and demonstrate a commitment to compliance.

How can I prevent disputes with participants?

You can reduce disputes by communicating clearly and transparently about participant rights, service agreements and complaint-handling processes. Establishing strong internal dispute resolution mechanisms and regularly reviewing participant feedback will help address concerns early, preventing conflicts from escalating into formal complaints or legal action.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.