“Fever dream high in the quiet of the night, you know that I caught it”
Part 1: Introducing Absolute Power within the NDIS
Evidence check — 10 September 2026
This article was published in December 2024 and has not been rewritten. The dated notes below score it against the evidence now available — where later evidence supports the argument, where policy changed the ground underneath it, and where a claim does not hold up. Part 1 of five.
The Impact of Absolute Power
The National Disability Insurance Scheme (NDIS) has revolutionised care access and support for people with disabilities in Australia. However, with its unprecedented scale and government backing, it has inadvertently created an environment vulnerable to inefficiency, exploitation, and systemic failure.
The old adage, "absolute power corrupts absolutely," rings particularly true here.
Nowhere in healthcare has this been more evident since Medicare, where capped rates and unchecked volume-based billing models created significant inefficiencies. This year, for example, general practice clinics reported financial strain due to outdated pricing structures, which incentivised excessive service volumes to maintain viability.
A parallel can be drawn to the NDIS: vast amounts of funding have flowed into the system over the past decade, but the mechanisms to ensure efficiency and quality have not kept pace.
Inefficiency and Rorting in the NDIS
Wherever governments allocate significant funding, inefficiency and waste often follow. Within the NDIS, this issue is compounded by price caps that fail to reflect the true costs of delivering high-quality, patient-centred care for complex cases. While small, ethical businesses have worked to operate within these constraints, the broader system has become rife with rorting and inefficiencies.
One area of contention is the pricing of reports by allied health professionals. For instance, some reports by occupational therapists may cost upwards of $1,500. While this may reflect the complexity of certain cases or the documentation requirements, there is growing debate about whether such costs could be reduced with the integration of technology. Advances in artificial intelligence and data automation could streamline aspects of report generation, potentially allowing skilled professionals to focus their expertise where it’s needed most.
This is not to suggest that all providers are overcharging or that technology can replace human judgment entirely. The issue often lies at the intersection of outdated systems, inconsistent practices where goal posts keep moving, and occasional unethical behaviour. Unfortunately, these inefficiencies leave participants underserved and erode public trust in the scheme.
To better serve participants and protect taxpayer investment, the focus must shift toward aligning funding with genuine outcomes and ensuring resources are used effectively to support those who need them most.
Evidence check — 10 September 2026
The independent review had already found the same mechanism
The claims above — that capped rates fail to reflect the cost of complex care, and that the system rewards throughput rather than outcomes — have independent support, and the chronology is worth stating plainly. The independent NDIS Review had reported on pricing before this article was written. It found that “price caps are applied bluntly in the scheme”, that around 80% of NDIS payments in the December 2022 quarter were subject to a cap, that caps “act more as a ‘price anchor’ than a ‘price ceiling’”, and that providers have “little incentive to compete on price or quality”. It also recorded that current price caps “do not support the supply of services to participants with more complex needs” and that some providers cannot invest in workforce capability under them. NDIS Review, The role of pricing and payment approaches.
On the volume incentive, the Review’s provider fact sheet is blunter: market settings, it says, “have encouraged a focus on the number of supports provided” and have not given enough attention to quality or outcomes. Its recommendation was to move away from a one-size-fits-all cap and away from the fee-for-service model itself, toward payment approaches that “better reward providers for helping participants to achieve their goals”. NDIS Review, fact sheet for disability service providers.
The strongest version of the argument in this article was therefore not made by us. It was made by the review panel, inside the government’s own process, and it was already on the public record when this piece was written. What has not happened in the years since is the change it recommended.
Expertise: The Missing Piece of the Puzzle
One critical issue is the underutilisation of highly skilled practitioners.
For example, my partner, is a senior occupational therapist with 17 years of experience in neurological injury.
Yet, she no longer works within the NDIS despite her extensive expertise.
Why? The reasons are threefold:
- Bureaucracy: The administrative burden placed on clinicians is immense, detracting from their ability to focus on delivering care.
- Undervaluation: Expertise is poorly rewarded, with capped rates failing to reflect the skills required for complex cases.
- Non-clinical Oversight: Practitioners often must justify clinical decisions to support coordinators and funds managers with no health background. This misalignment of authority erodes trust and diminishes efficiency.
Problem #1: The practitioners designing programs for these highly complex patients are not experts.
The Iceberg Beneath the Surface
These challenges represent only the tip of the iceberg. As the NDIS continues to evolve, it must address these systemic inefficiencies to ensure that funding achieves its intended purpose: empowering participants with high-quality, meaningful support.
The next sections of this series, released over the coming days, will explore targeted solutions to address these inefficiencies, including adopting a barbell strategy to optimise expertise and reforming funding mechanisms to better reflect the complexities of care delivery.
Part two is now available discussing The Systemic Shortcomings of the NDIS Care Model.
Why This Matters:
Despite numerous government reports and think tank publications exploring the NDIS, truly actionable solutions have remained elusive. Recent policy changes, such as the removal of Music and Art therapists, have inadvertently harmed participant wellbeing while failing to tackle the system's fundamental inefficiencies. Often, these decisions, although presented as evidence-based, tend to reflect political convenience rather than genuine reform. The strategy of targeting smaller providers to cut costs sidesteps the larger, structural issues at the core of the program.
Over the past decade, the NDIS has evolved into a $40 Billion+ initiative. Yet, it has become synonymous with inefficiency, unethical practices, and fraud. This state of vulnerability demands immediate attention. Meaningful reform is urgently required to protect participant outcomes and safeguard taxpayer investments.
At Culture of One, we hold accountability, transparency, and ethical leadership as paramount for governments, providers, and all stakeholders involved. This series provides a comprehensive exploration of the sector’s challenges and opportunities. It’s not a quick read, but it is a necessary one for anyone committed to understanding and improving the landscape of disability care in Australia.
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