Navigating the National Disability Insurance Scheme (NDIS) can be challenging for service providers, who often encounter payment issues when the National Disability Insurance Agency (NDIA) refuses payment for various reasons. Providers are left with substantial debts and uncertainty about what to do.  

Recent Decision

A recent decision by the Administrative Appeals Tribunal of Australia (AATA) sheds light on key issues facing NDIS providers and raises concerns about their ability to recover debts.

In Lifeful Coordination & Management Pty Ltd and National Disability Insurance Scheme [2023] AATA 155, two key issues were considered:

1. whether an NDIS service provider, in this case, a plan manager, could appear as an applicant to appeal a decision made by the NDIA; and

2. whether the AATA has the power to review a decision made by the NDIA to refuse payment.

In the noteworthy ruling, the AATA determined that the provider could not initiate an application against the NDIA for payment of the debt. The Tribunal reasoned that the debt, in this particular case, was a private matter between the provider and the participant.

The Tribunal also determined that it did not have the power to review the NDIA's decision regarding payment. The reason cited for this decision was that the provider had not completed an internal review process with the NDIA.

Why you should be worried

Providers often do not know that a participant has run out of funding until a substantial debt has accrued. Plans can be reviewed, but reviews might not result in a provider getting paid for outstanding debts. 

So what happens if you disagree with an internal review about a funding decision? Other interested parties can ask the AATA to intervene. You can’t. As a provider, you either have to wear the debt or take action against other people to enforce your right to payment. Usually, that means enforcing contractual and common law rights, usually against the participant. However, many providers don’t know what their rights are or how they go about exercising them lawfully and ethically. 

What should I do? 

This recent AATA decision is discouraging. But it is important to remember that providers still have other ways to recover unpaid service fees. We often help NDIS providers understand their options and resolve payment problems. To learn more about how we can help, call us now on 02 9199 4563 or email to info@kinnylegal.com.

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