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.