Recent media reports about the National Disability Insurance Scheme fraud have invariably raised a sore point for the sector around the role and regulation of unregistered providers.
Unregistered providers are businesses that provide services to NDIS-funded participants despite not being registered with the NDIS.
They range from gardeners to personal care workers to allied health providers.
At a Senate committee hearing last year, then acting NDIS Quality and Safeguards Commission head Tracy Mackey said there were about 4,000 unregistered providers claiming under the NDIS (an exact figure was unavailable).
Labor Senator Tony Sheldon told the same committee hearing there were “more checks and balances when buying a beer than … on the provisions of unregistered NDIS services,” pointing to the responsible service of alcohol course for those working in pubs and bars.
He would be right.
Registration of all providers under the NDIS should be an absolute non-negotiable.
How can the NDIS Quality and Safeguards Commission regulate what it can’t see?
Further, if a business is to avail itself of taxpayers’ money, then it is reasonable to require a level of accountability from it.
As a bare minimum, the National Disability Insurance Agency should know who is on the commission’s payroll and whether the workers have been screened.
However, all the regulation in the world is pointless and even counterproductive if it isn’t keeping the beneficiaries of the scheme safe, giving them choice and control, and stopping rorting.
Firstly, there is the issue of supply. Unregistered providers don’t necessarily rely on NDIS clients as their core business, yet they make up 90 per cent of the Australian disability sector (and the fastest-growing part).
In rural and remote regions, and in this workforce crisis, they are the backbone of a system that would crash overnight if they were shut down or exited the NDIS.
Many unregistered providers will avoid what they see as disproportionate regulatory burden, particularly where they don’t have direct contact with clients (a gardener, for example) or where they are already regulated under their own professional standards (occupational therapist).
Secondly, there is the issue of system navigation and its impact on quality and choice and control.
According to Coralie Flatters, state manager for Australia’s peak industry body for non-government disability service organisations, National Disability Services, the real issue is how the NDIS is set up to deliver quality of service, not whether all providers should be registered per se.
Under the NDIS, the marketplace created by giving participants a package of funding is meant to generate the competition to reward high-quality providers at the expense of low-quality providers.
Theoretically, participants will choose providers (and move providers) based on the quality of service provided.
However, the opaqueness of the NDIS, the lack of system navigators and advocates, and the lack of providers in rural and regional markets means the mechanism meant to serve as the arbiter of quality is failing.
“We haven’t got any layers of information that provide signals to the customers to allow them to assess quality and fit and then make choices,” Ms Flatters told Business News.
So, funding might attach to a participant, but it is difficult to move around when there there is no visibility.
Registering providers isn’t going to fix this issue, neither is over-regulation.
The issue here is navigation, not registration and regulation.
Finally, registration of providers seems unlikely to assist in preventing rorting while the NDIA continues to be understaffed.
While it was projected to need almost 11,000 staff by 2018-19, average staffing levels for the NDIS in 2022-23 are budgeted at only 4,500.
It does not seem too much of a stretch to suggest that, even if all providers were registered, the NDIA simply doesn’t have enough staff to detect fraudulent activity across 520,000 participants and their providers.
In circumstances like these, there is always the temptation to turn the problem into a binary one.
The proposition that registered NDIS providers are ‘good’ and unregistered providers are ‘bad’ is an easy jump, which suggests an almost immediate solution.
The truth is, it is never that simple, and to allow the conversation to become that simple is a disservice to the people the system is intended to look after.