NDIS needs a pricing fix and the stakes are too high to delay

The NDIS is meant to deliver support, services and equipment to people with disability, not to subsidise overpayments or lining the pockets of unscrupulous providers. Yet recent reporting has renewed calls to overhaul the scheme’s pricing system, following glaring signs that without reform, NDIS funding remains vulnerable to serious misuse.

What’s prompting the call

• The current pricing model under the NDIS reportedly allows for overpayments when caps and guidelines are poorly enforced,  meaning providers may charge inflated prices for goods and services, or over-service participants.

• Observers argue this isn’t just a problem of a few “bad apples”: systemic design problems in pricing create recurring opportunities for exploitation.

• Some estimates suggest a substantial portion of NDIS spending – perhaps as much as one-fifth – may be vulnerable to fraud or inappropriate billing.

As the scheme expands and budgets tighten, those leaks in the system threaten to undermine not only trust, but the ability of the NDIS to deliver for future participants.

What reform advocates are calling for

Reform proponents are demanding a “pricing fix” that does more than tinker at the margins. Key proposals include:

• Revising the way price caps and limits are set, turning them into effective ceilings rather than flexible “anchors” that providers can easily exploit.

• Increasing transparency and oversight, especially around costs for goods (like aids and equipment) and services for people with disability.

• Strengthening compliance mechanisms so that providers who overcharge or engage in fraud face tangible consequences, including bans or legal penalties.

• Ensuring that pricing reflects need and value, not just profitability. That means cost structures should align with the real cost of delivering supports, not the convenience of providers.

What’s already being done – and why it’s not enough

There has been some progress. The NDIS Quality and Safeguards Commission (NDIS Commission) now enforces a “fair pricing” principle: providers must not charge an NDIS participant more than a non-participant for the same goods, unless they can justify the difference. Pricing guidelines and “price limits” are published under the National Disability Insurance Agency (NDIA)’s Pricing Arrangements and Price Limits framework.

Further, the Fraud Fusion Taskforce, established in 2022, works across multiple government agencies to detect and act on suspected fraud in the NDIS, including overcharging and mis-billing.

But many argue this isn’t enough: the underlying structure of price controls and the incentives built into the system still favour large payouts over value – and enforcement, even when active, can only do so much if the system allows overcharging in the first place.

What’s at risk: People with disability, and the future of the NDIS

Without a serious pricing reform, the consequences are more than financial.

• Participants may be overcharged for essential supports or pressured into unnecessary services, undermining the fairness and purpose of the scheme.

• Overpayments or fraud drain public resources, reducing the funds available for legitimate support and potentially limiting access for future participants.

• Trust in the NDIS erodes, making it harder for people with disability to confidently engage with the scheme.

• Long-term viability of the NDIS becomes threatened if unsustainable overpayments humiliate its budget and integrity.

What a proper pricing reform could look like

A genuine reform would probably involve:

• A comprehensive review of how price limits are calculated, based on actual cost data and market rates, with regular updating.

• Clearer, simpler pricing rules that are easily understood by participants, carers and providers.

• Greater transparency: published price-limit tables, accessible comparison points, and straightforward guidance for participants to compare with non-NDIS prices.

• Stronger enforcement: better complaint processes, swifter investigations, and meaningful penalties for overcharging or fraudulent behaviour.

• Ongoing oversight, possibly including greater regulation or registration requirements for all providers (registered or not), to avoid loopholes and unregulated operators.

Fixing pricing isn’t optional – it’s essential

The NDIS exists to support people with disability in living full, dignified lives. When the pricing system allows – even unintentionally – for overpayment or fraud, it undermines that mission.

Fixing NDIS pricing isn’t about cutting corners: it’s about building a fair, sustainable foundation so that the scheme can continue to deliver value, support, and trust. For people with disability, and for Australia, a robust, transparent pricing model should no longer be negotiable – it must be the standard.