As the NDIS moves to independent assessments, these companies stand to profit from the change

At first glance, the healthcare company Allied Care Group looks like just another small business trying to make its way in a crowded market.

Its headquarters is listed as an office suite above a bank branch in sleepy Kingscliff, just south of Tweed Heads.

The company seems an unlikely candidate for a massive federal government contract worth potentially hundreds of millions of dollars over the next five years.

Yet in February this year, Allied Care Group was one of eight organisations picked to roll out a controversial new eligibility testing regime for the 400,000 participants in the National Disability Insurance scheme.

The company’s contract will likely involve tens of thousands of assessments around the country — a huge undertaking for a firm with no apparent record of delivering major government projects.

But behind Allied Care Group’s humble facade stands an emerging giant of Australia’s disability support industry.

The company is in fact a subsidiary of Zenitas Healthcare, a disability and aged care juggernaut with almost 5,000 staff and more than $250 million in revenue last financial year.

Its chief executive is Rob De Luca, a former head of the National Disability Insurance Agency (NDIA), the agency which runs the NDIS.

A major question is that given Zenitas Healthcare’s expertise in disability services, why did it decide to apply for the contract to provide so-called independent assessments through a subsidiary rather than directly?

It appears that by tendering through Allied Care Group, Zenitas has not been subject to strict conflict of interest rules designed to prevent existing NDIS providers from conducting independent assessments.

“The NDIA will not issue any work order or referral forms in respect of assessment services in areas whether the tenderer (or any of its subcontractors) is also … a registered NDIS provider,” last year’s request for tender from the NDIA reads.

“Tenderers should not tender for such areas.”

In other words, companies that already provide NDIS services were blocked from tendering for the independent assessment contract in areas where they already operate.

ABC Investigations has spoken to other tenderers for the contract who believe the rule was designed to stop companies acting as both gatekeeper and service provider in the NDIS.

That was potentially a big hurdle for Zenitas, whose NDIS footprint extends across the country.

Its two major businesses, Plena Healthcare and Claro Aged Care and Disability Services, are registered in every state and territory to offer services including physiotherapy, speech pathology, personal care and specialist disability housing.

But because Allied Care Group does not offer any NDIS services, it was not in breach of the conflict of interest exclusion in the tender.

In a letter sent to tenderers in July last year, obtained by ABC Investigations, the NDIA said it would consider tenders from subsidiaries of NDIS providers.

NDIA to consider conflicts of interest

“However, tenderers must set out any actual or potential conflicts of interest in their tender. The NDIA will consider any identified conflicts of interest as part of its evaluation of risk,” the letter said.

An NDIA spokesperson said it was aware that organisations carrying out independent assessments “may also contain other operations within their group that may perform other services as a provider or partner”.

“The organisations within these groups are structured and operate as separate legal entities, with discreet systems, processes, workforce, resources and management structures,” the NDIA spokesperson said in a statement.

“If there is a perceived conflict of interest, the NDIA and organisations manage these via a conflict of interest management plan.”

Autism Awareness Australia chief executive Nicole Rogerson said the disability community was concerned about potential conflicts of interests among independent assessment contractors.

“It seems that some of these companies are set up and structured as a web of companies that are profiting from every pillar of the NDIS system,” she said.

“We need to get to the bottom [of this] to make sure that all of those conflicts have been investigated and ultimately the NDIS is serving individual Australians with disability and not just lining the coffers of multi-million dollar corporates.”

Former NDIA chief executive David Bowen says his former agency must maintain a strong separation between assessors and NDIS providers — especially if they are part of the same parent company.

“It certainly shouldn’t be the case that an assessor employed by a subsidiary company is dealing with a participant from their parent company,” he said.

However it appears there has already been some blurring between Zenitas Healthcare’s NDIS provider companies and Allied Care Group.

Job advertisements posted on seek.com show Plena Healthcare has been advertising for independent assessor positions, even though it does not hold the contract for the assessments.

Zenitas declined to comment when contacted by the ABC.

David Bowen believes all companies carrying out the independent assessments should disclose any potential conflicts of interest to participants they are dealing with.

“The more information in a participant’s hands, the better that they are able to deal with the circumstances.

“There’s nothing wrong with telling a participant and the whole sector where the assessor comes from and what their other relationships are.”

He has also added his voice to criticism of the new independent assessment model, which is expected to be introduced later this year.

“I think the government’s doing this to save money,” he said.

“It’s a way of controlling the amount of funds that go into each plan, through determining that plan value through an assessment tool, rather than through a personalised plan.”

Until this year, applicants for the NDIS have relied on evidence from their treating doctors and expert medical reports to prove their eligibility and help determine their funding.

Under the new model, applicants will be examined by private contractors — including Allied Care Group — using questionnaires and other tools designed to assess capacity.

The Minister for the NDIS Stuart Robert insists the model will ensure equity in the scheme.

“The government believes access to the scheme and a NDIS participant’s plan should not be determined by your postcode or how much someone can pay for a report and will be progressing with the widely consulted on reforms,” a spokesman for the Minister said.

“The government completely rejects any insinuation of any impropriety of the arms-length process run by the NDIA to appoint independent assessors,” the spokesman said.

The Minister said two weeks ago that the independent assessments were strongly recommended by the Productivity Commission when it built the scheme in 2011.

But Mr Bowen said the Productivity Commission recommended independent assessments as part of a range of assessment tools to measure a participant’s disabilities and support needs.

“This was never a one-size-fits-all model. This was about personalised plans, recognising the individual circumstances of people.”

“Now they’re introducing an assessment where you see someone who has no knowledge of your history [and] no personal relationship with you.”

“I think that’s woeful.”

People will ‘fall through the gaps’

Bianca Rossetti and her 15-year-old son Matthias have already experienced the new model through a pilot of the independent assessment process currently underway around the country.

An independent assessor came to their Canberra home earlier this month to conduct a capacity assessment with Matthias, who is an NDIS participant with autism.

“Matthias was just not interested in meeting this lady and he didn’t really understand the process of it. He just walked away.”

Ms Rossetti, who is also chair of advocacy group ACT Mental Health Consumer Network, said she was left to answer the assessor’s questions on her son’s behalf.

“It wasn’t a true representation, because it was just my perspective.”

Ms Rossetti believes many NDIS participants will have difficulty communicating their needs during the assessments.

“Because I’m involved in the NDIS as a mental health advocate, I can articulate what is needed,” she said.

“People who can’t articulate for themselves are going to fall through the gaps.”

One of the organisations running the pilot is Advanced Personnel Management — a Perth-based based company that has also won a tender to carry out independent assessments over the next three years.

APM is already a major NDIS contractor, which according to contract documents has earned more than $86 million from the agency to run its local area coordination services in parts of Western Australia, the Northern Territory and Queensland.

Local area coordinators (LAC) act as a participant’s first point of contact in the scheme, and are supposed to help connect them with disability support providers.

Under the rules of the independent assessments tender, LAC providers are meant to be blocked from contracting for assessments in areas where they already operate.

Yet an APM subsidiary called Konekt won the tender to deliver independent assessments in areas where its parent company is an LAC provider.

For example, in parts of Perth and southern Western Australia where APM is contracted for LAC services, Konekt has been awarded the tender to deliver independent assessments.

APM declined to respond to questions about whether this meant it was in breach of the conflict of interest provisions.

In its statement, the NDIA said there was “no instance” in which an organisation could carry out independent assessments in areas where it provided support services.

It said organisations carrying out independent assessments could contain other operations within their group that may perform other services, but the organisations with these groups operated as separate legal entities.

The global medical assessment company Medhealth also successfully tendered for the independent assessment contract through its workplace injury rehabilitation subsidiary, Ipar.

Medhealth also owns Ability Action, an NDIS provider that offers services around the country.

Arriba Group, which owns NDIS provider LiveBig, also successfully tendered to provide independent assessments through its other company, Rehab Management Australia.

The ABC contacted Medhealth and Arriba Group for comment, but both referred the questions to the NDIA.