NDIA implementing data-matching and analytics to thwart fraudulent claims

In probing its fraud prevention capabilities, the Australian National Audit Office has asked the agency to prioritise such activities.

The Australian National Audit Office (ANAO) has tabled its report into the National Disability Insurance Scheme (NDIS) Fraud Control Program, asking the National Disability Insurance Agency (NDIA) to prioritise its data-matching and analytics capabilities to prevent fraudulent claims.

Making a total of six recommendations, ANAO asked in one of them that the NDIA improve its active fraud detection methods by implementing the planned data analytics and data matching activity as a matter of priority, and on a continuing basis.

In response, NDIA said that as part of the Fraud and Compliance Roadmap, it has prioritised investment in data analytics and matching, infrastructure, and data analysts.

"This has enabled the NDIA to stand up both data analytics and matching capabilities to proactively detected fraud and non-compliance," the agency said.

The NDIA commenced data-matching activities in 2018.

"The NDIA has acquired the data storage and analytical tools to necessary to progress its data matching strategy," it continued. "The NDIA has already entered into formal arrangements with six government and non-government organisations to acquire data with further arrangements currently being negotiated or planned."

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In its report, ANAO said the NDIA continues to invest in building its data-matching capability, noting that in February this year, the NDIA Risk Committee said its new Identity Management Framework was aiming to strengthen identity controls for participants seeking access to the NDIS by accessing and using third party data sets.

This includes matching data from government and non-government organisations.

ANAO said the NDIA's actuarial team routinely undertakes payment integrity activity where it matches participant data with state and territory data to ensure that the correct government entity is paying supports.

As an example, ANAO said the NDIA received its first set of "fact of death" data in March 2019 and compared it with participant information to identify discrepancies.

The NDIA also receives information from the Department of Education Child Care Enforcement Action register regarding Family Day Care providers that have been sanctioned.

The NDIA matches this data to its own providers and investigates as required. As at February 2019, the NDIA had engaged with 38 NDIA providers following this data matching activity, and is in the process of de-registering 25 providers, ANAO said.

"The NDIA has identified that providers with sanctions against them in the Department of Education Child Care Enforcement Action register have made AU$3.6 million in service bookings and have received payments totalling AU$2.3 million from the NDIA," the auditor wrote.

"The NDIA advised the ANAO that it is in the process of implementing this check as a pre-registration step, at which time the data-matching will become a 'business as usual' activity."

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The NDIS Fraud Taskforce was stood up in July 2018, supported by the Australian Federal Police (AFP) and the Department of Human Services, now Services Australia.

At the time, it was said the establishment of the NDIS Fraud Taskforce was "to mitigate potential serious fraud within the NDIS which is being reported both through intelligence sources and in the media".

In 2018-19, the NDIA allocated AU$16 million for business as usual fraud and compliance activities, including for approximately 75 staff. In addition, AU$7.7 million was allocated for the NDIS Fraud Taskforce in 2018–19.

ANAO said as of 30 March 2019, the Fraud and Compliance Branch had 103 staff either working on the NDIS Fraud Taskforce or business as usual activities. 12 of these NDIA staff were dedicated to the NDIS Fraud Taskforce, while Human Services' had committed 15 staff, including those with access to AFP resources.

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