austlii:cth/ARTA/2025/486
General information, not legal advice.
ARTA
2025-04-11
Senior Member P
Original judgment source is linked above.
Pizzinni and National Disability Insurance Agency (NDIS) [2025] ARTA 486 (11 April 2025)
Respondent: CEO, National Disability Insurance Agency
Tribunal Number: 2024/9251; 2024/9181; 2024/8760
Decision: Application no.s 2024/9251, 2024/9181 and 2024/8760 are each dismissed pursuant to 101(1)(a) and (c) of the Administrative Review Tribunal Act 2024 (Cth) on the grounds that they misconceived and are otherwise an abuse of process.
........................[SGD].........................
Catchwords: NATIONAL DISABILITY INSURANCE SCHEME - claims for recovery of costs incurred by support provider - where approved funding exhausted - whether the impugned decisions are reviewable decisions - whether there has been an internal review of any reviewable decision - whether an application can be made by person who is deceased - whether a Support Coordinator can authorise a support provider to make an application for review on behalf of a participant - whether a support provider has a conflict of interest in representing a participant to whom they provide support in an application for review - where applications are in substance made by a support provider - no jurisdiction - applications misconceived - applications an abuse of process - applications dismissed.
National Disability Insurance Scheme (Supports for Participants) Rules 2013
Carroll and National Disability Insurance Agency [2022] AATA 2822
Complete Nursing and Home Care Pty Ltd and National Disability Insurance Agency [2022] AATA 360
Deacon and National Disability Insurance Agency [2022] AATA 3209
Gaudron and National Disability Insurance Agency [2021] AATA 615
Glasshouse Community Supports Pty Ltd [2024] AATA 816
Jones and National Disability Insurance Agency [2023] AATA 2014
LinkAssist Pty Ltd and National Disability Insurance Agency [2023] AATA
Nganana Incorporated and National Disability Insurance Agency [2023] AATA 2906
Pascu and National Disability Insurance Agency (NDIS) [2025] ARTA 32
PTJR and CEO, National Disability Insurance Agency [2025] ARTA 196
QDKH, by his litigation representative BGJF v National Disability Insurance Agency [2021] FCAFC 189 189
13Homecare and National Disability Insurance Agency [2023] AATA 793
(a) decisively: > > > (i) with respect to application no. 2024/ 9251, the Late Mr Joseph Pizzini is no longer a legal person capable of making an application for review. He died on 10 December 2022. The Late Mr Pizzini's Estate became a legal person on his death. However, his Executor obtained a grant of probate and distributed his Estate over a year ago. The Estate has ceased to exist, and having performed her obligations, its Executor is no longer capable of instituting or authorising legal action on its behalf; > > > > (ii) with respect to application no. 2024/9181 Zekusic, a decision by the Agency to suspend payments to a NDIS Registered support provider is not designated a reviewable decision in the Table to s 99(1) of the National Disability Insurance Scheme Act 2013 (Cth) ('NDIS Act') or otherwise. The Administrative Review Tribunal ('Tribunal', 'ART') does not have jurisdiction at large. Section 12 of the ART Act provides that an administrative decision will only be reviewable by the Tribunal if an Act or legislative instrument provides for an application to be made to the Tribunal for review of the decision; > > > > (iii) with respect to all three applications, the administrative decisions to which they relate are, in substance, decisions of the Agency pursuant to s 45 of the NDIS Act that amounts claimed by AIHCS are not amounts payable under the NDIS in respect of each participant's plan. Such decisions are also not designated reviewable decisions in the Table to s 99(1) of the NDIS Act, and consequently, this Tribunal has no jurisdiction to review such decisions; > > > > (iv) with respect to all three applications, while it is possible to identify in the chronology of events at the material time for each case participant plan related reviewable decisions made by the CEO, or which might be deemed to have been made by the CEO, there is no evidence that any of those decisions was subject to a valid request for internal review. No internal review was conducted in relation to any of these decisions, and the facts and circumstances in each case do not indicate that a deemed internal review decision materialised from any failure by the CEO to respond to an internal review request. This Tribunal's jurisdiction is only enlivened when, relevantly, an internal review decision is made by the CEO, or is deemed to have been made by the CEO, and independent review of such a decision is sought by an applicant. > > Additionally, > > > (v) the applications are, in substance, made by AIHCS, naming Mr Pizzini, Mr Attalla and Mr Zekusic as applicants. The Late Mr Pizzini, Mr Attalla and Mr Zekusic are not Applicants in any genuine sense. Even if these applications did arise from an administrative decision that is designated a reviewable decision under the NDIS Act, only a person who is directly affected by such a decision has the legal right (standing) to seek review of such a decision. In the circumstances of these cases, the only person who can be directly affected by such a decision is the participant themselves, or their proper representative. A NDIS support provider is incapable of being a person directly affected by a participant plan related reviewable decision, albeit that they may be indirectly affected by such a decision. A NDIS support provider therefore does not have standing to apply for independent review of a participant plan related reviewable decision and cannot overcome that difficulty simply by naming as the applicant a person to whom they provide support; > > > > (vi) even if these applications arose from a reviewable decision, and the named participants were genuinely the applicants for review, AIHCS is not an appropriate representative of these applicants because its financial interests are the central concern in each application. AIHCS's financial interests are not co-extensive with the interests of the participants. The potential for conflict of interest is manifest. For this reason, even if AIHCS had been authorised by each participant or their proper legal representative to represent them, it ought properly to be prevented from doing so by the Tribunal by order made pursuant to s 66(3)(a) of the ART Act. If persons associated with AIHS had a role to play in such a review, it would be as a witness only.
8 Mar 2022 the Agency initiated an 'unscheduled' s 48 reassessment of the Mr Pizzini's Participant Plan. > > 31 Mar 2022 Ms Faga submitted a request to the Agency for a s 48 reassessment of Mr Pizzini's Participant Plan. > > 23 May 2022 the Agency conducted the unscheduled s 48 reassessment of Mr Pizzini's Participant Plan > > 3 June 2022 a delegate of the CEO approved a new SoPS for inclusion in Mr Pizzini's Participant Plan which was expressed to commence from 3 June 2022 with a review date of 3 June 2023. > > 11 Aug 2022 Mr Pizzini's Plan Manager sent an email to AIHCS and Ms Faga which had as its subject line "Joe Pizzini - urgent request for documentation for review". The body of the email states: > > "Hi > > A review for Joe is imminent due to the funds in the current plan at serious risk of exhaustion - can you please send a summary report on how Joe is going with his overnight services. If Joe has settled in well at home, we will need to discuss moving services to inactive overnights as per the initial Occupational Therapist report from NSW Health. > > In line with consent from Cathy Farga and Cathy's request to AIHCS allied health services, can we ask for the reports to be sent through this week as per previous communication. > > This current plan is an interim plan to get Joe home from hospital and the reports that need to go in for the review are as per below.
..." > > 22 Aug 2022 Mr Pizzini's Plan Manager forwarded a copy of its email of 11 August 2022 to AIHCS and Ms Faga again, stating: > > "Hi AIHCS and Cathy > > We are needing to receive the reports as per the email below. We have noticed that the 24-hour support has continued and will need to receive the documents below for the review asap. Can you please send an update and progress notes on the service being provided. The support for nights needs to be reviewed. [AIHCS] can you please respond to this email to advise on this and update on how Joe is going with sleep and wake times. > > Please let us know today if you have not conducted the necessary assessments so that we can engage other service providers to provide this support to Joe for his upcoming review requirements. > > Please see this enquiry and request as a matter of urgency". > > Sept or Oct 2022 A functional capacity assessment is undertaken in relation to Mr Pizzini by Concentric Rehabilitation Centre. > > 6 Oct 2022 a representative of the Agency contacted Ms Faga and his Support Coordinator, Ms Hopkins to inform them that funding available under Mr Pizzini's SoPS had been exhausted and that a plan review request had been made of the relevant section of the Agency, which would be in contact. The Agency's file does not contain any record of the proposed plan review and no further contact to or from Ms Faga is recorded by the Agency. > > Sept and/or Oct 2022 on behalf of AIHCS Mr Wallace submitted a letter of demand to the Agency for payment of a debt he contended was owed to AIHCS which had not been approved for payment by the Plan Manager because funding for supports in Mr Pizzini's SoPS had been exhausted. > > 16 Oct 2022 Mr Wallace attended the Surry Hills offices of the Agency and requested a response to the letter of demand AIHCS had sent to the Agency for payment of debts alleged to be owed in relation to Mr Pizzini's support. Mr Wallace stated that he required a response to that letter so he could apply to the AAT for review of the Agency's decision to refuse to pay the amount claimed. The Agency's file record notes that Mr Wallace was referred to the Plan Manager because Mr Pizzini's Participant Plan was plan managed. > > 2 Nov 2023 Mr Wallace, as Director of AIHCS, made a complaint to the Commonwealth Ombudsman concerning the Agency's refusal or failure to pay debts said to be owed to AIHCS in relation to several participants, including the Late Mr Pizzini. > > 31 Dec 2022 Ms Hopkins submitted a payment enquiry to the Agency via its on-line portal attaching AIHCS invoices for support provided to Mr Pizzini for the period 24 October to 10 December 2022 requesting payment. > > 12 Jan 2023 the Agency locked payments on Mr Pizzini's account, apparently upon notification of his death. > > 17 Jan 2024 Mr Wallace, on behalf of AIHCS, made a complaint to the NDIS Quality and Safeguards Commission about debts alleged to be owed to AIHCS by the Agency in relation to several participants, including the Late Mr Pizzini. The amount claimed in relation to Mr Pizzini was stated as $74,975.88 in respect of the period 24/10/2022 to 10/12/2022. Under the heading "Reasons for Difficulty Billing at the time" the following is stated: > > "Joe went backwards quickly in the last 6 weeks of his life. We got approval for 2 people to look after him during the final few months of life. Death payment and forensic clean invoices + last 6 weeks of service with 2 Care workers leading up to his death remains unpaid. Plan management company (Ulladulla plan management) folded 1-2 weeks after he died, and we never received the final invoice payment". > > 19 Feb 2024 Mr Wallace, as Director of AIHCS, wrote to the Minister responsible for the NDIS to complain about amounts claimed to be owed to AIHCS by the NDIA in respect of several clients including the Late Mr Pizzini. > > 22 Feb 2024 Mr Wallace on behalf of AIHCS submitted another letter of demand to the Agency requesting payment of $74,975.88 in respect of support provided to Mr Pizzini during the period 24 October to 10 December 2022. > > 6 Mar 2024 a delegate of the Agency notified Mr Wallace of the action the Agency had taken in relation to his claims for payment of amounts in respect of several clients, including The Late Mr Pizzini. Mr Wallace was advised that his "claims [had] been reviewed for each participant and the outcomes were emailed to [him]... This Claim and Payment Enquiry is now closed." > > 8 Mar 2024 the Agency responded to Mr Wallace's complaints to the Minister responsible for the NDIS about debts allegedly owed to AIHCS, including in relation to Mr Pizzini, advising that as Mr Pizzini's Participant Plan had been Plan Managed, his enquiries would need to be directed to the Plan Manager. > > 1 May 2024 Workersweb Pty Ltd trading as Australian In-Home Care Specialists filed application no. 2024/2825 with the AAT. The decision sought to be reviewed was the payment request made to the Agency on 31 December 2022. In the section of the form that requires the applicant to identify the reason why the decision is wrong, the following is stated: > > "The NDIS has a duty to its participants to provide URGENT REVIEWS for those who qualify to allow participants choice and control who provides their service. The slow ndis review process took more than 2 months and the patient died during this period. > > This is the 6 week gap period, which has still never been paid, where the old funding ran out due to his drastically declining health. > > The fact that I even need to take this to AAT is a complete joke." > > 3 May 2024 the Agency responded to Mr Wallace's complaints relating to the non-payment of invoices submitted in relation to the Late Mr Pizzini as follows: > > "This correspondence is in relation to your Payment Enquiry ... for the late Participant ... regarding your 6 invoices ... total amount $74,975.88. > > Your claim has been reviewed ... and we are unable to make the requested payment as the Participant's plan/support category budget has been consumed. Also, the level of supports provided exceeds the budget approved in plan that has caused the overutilisation of the plan. > > Please note that as per NDIS Act 2013 Section 46 Acquittal of NDIS amounts (1): A Participant who receives a NDIS amount, or a person who receives a NDIS amount on behalf of a participant, must spend the money in accordance with the participant's plan. While the funding in a participant's plan can be flexible to support their choice and control with the services and supports they access, the NDIA is not obligated to pay for supports over and above what have been considered reasonable and necessary. > > Whilst I understand that this is a sensitive matter as Joe has passed, further information or clarification would need to be provided to Joe's nominee or Executor of his estate. Whilst I acknowledge you have provided a Legal Authority to Act form, this is not sufficient to share particular information that we may hold. .... > > 17 June 2024 Ms Fago submitted a "letter of demand" to the Agency requesting that it pay AIHCS $87,471.86 being alleged debts owed to AIHCS related to Mr Pizzini's care during the last 7 weeks of his life. > > 19 June 2024 Mr Wallace submitted a request to the Agency via its enquiries email address which had as its subject "JOE PIZZINI REVIEW REQUEST, and which stated: > > "We required a reviewable decision to take to the AAT. > > Your payment enquiry team has denied both our company and his plan manager over 5 requests for the final $87,471.86 we are owed for the last 7-8 weeks of 24/7 service in the final weeks of his life. > > Its so obvious that a change of circumstances and increased needs of service occurred and his needs changed drastically in the last months of his life. > > The estate of Joe Pizzini has asked us to represent them to chase this last interim plan that he needed in the last 7 weeks of his life. > > ... > > 25 June 2024 application no. 2024/2825 was listed for an Interlocutory Hearing (dismissal) at the request of the Agency. > > 26 June 2024 Mr Wallace, acting on behalf of AIHCS, withdrew application no. 2024/2825 and it was dismissed. > > 3 Nov 2024 Mr Wallace submitted a further request to the Agency titled "JOE PIZZINI REVIEW REQUEST", copied to the NDIS Quality and Safeguards Commission via its enquires email address. That email incorporates the text of his 19 June 2024 email and additionally states: > > "... > > I will repeat the question from the estate: > > "Will the ndis be providing an interim plan for Joe Pizzini for the amount $87,471.86 between the dates of 16/Oct/2022 until 10/12/2022." > > We have already submitted a mountain of evidence providing this is undoubtedly reasonable and necessary. > > We will reactivate our previous AAT case... if this request is denied. > > Previously we couldn't move forward with this case because we didn't have a reviewable decision. > > The lack of urgency around Joe receiving an urgent interim plan at the time (despite several calls to urgent NDIS team and his LAC) was beyond negligent..." > > 6 Nov 2024 a representative from the Agency's National Contact Centre responded to Mr Wallace's 3 November 2024 request by referring (and incorporating) the Agency's response dated 3 May 2024. At the end of that email the representative states: "This payment enquiry is now closed". > > 12 Nov 2024 the present application, naming Mr Pizzini as Applicant, was filed by Mr Wallace, purporting to be his representative. > > 26 Nov 2024 the Late Mr Pizzini's former Support Coordinator, Ms Hopkins, made an application to the Agency for payment of $74,975.88 in respect of Core Support for Mr Pizzini during the period 24 October 2022 to 4 December 2022.
The Public Guardian consents to the release and exchange of Mr Zekusic's personal and private information to facilitate collaboration with other agencies or health professionals in the development of his support service. Any shared information about Mr Zekusic must be treated as confidential outside of the agreed release and exchange process. This consent includes sharing his NDIS Plan to relevant service providers. This consent includes Bright Upwards accessing the NDIA Portal, receiving access to any required activation codes and sharing his NDIS Plan to relevant service providers and uploading/requesting any Change of Circumstances or other application forms and being endorsed as a provider.
Oct 2022 Mr Zekusic was referred to AIHCS as a prospective client by his Behaviour Support Practitioner. At that time Mr Zekusic was living in accommodation with SIL support provided by another disability support provider. > > By 5 Nov 2022 AIHCS had commenced providing support to Mr Zekusic although he continued to live in accommodation with SIL support provided by the other provider. > > 21/22 Nov 2022 a request was made by Mr Zekusic's Support Coordinator/Plan Manager to the NSW Trustee and Guardian for approval of a change in SIL placement for Mr Zekusic. This request was associated with a proposed service agreement with AIHCS. It also appears that an Agency 'Change of Circumstances form" was forwarded to the Guardian for approval, which proposed increased intensity (1:1) disability support worker assistance for Mr Zekusic.[2] > > 24 Nov 2022 the Support Coordinator notified AIHCS that she would submit the Change of Circumstances form to the Agency. > > Oct-Nov 2022 both AIHCS and the other service provider make claims for payment for providing support services to Mr Zekusic, with the result that AIHCS's claims are not processed for payment. > > 13 Dec 2022 NSW Trustee and Guardian writes to AIHCS to consent to it providing a SIL placement for Mr Zekusic. That letter states in part: "our consent is limited to agreeing that AIHCS will provide a service that meets Mr Zekusic's needs as identified in his NDIS Plan. Any costs to Mr Zekusic not funded by his NDIS Plan must be approved by his financial manager or enduring power of attorney. ... If you have any concerns about Mr Zekusic, the implementation of his NDIS plan or this consent, please contact the Public Guardian ...." > > 15-17 Dec 2022 Mr Zekusic's Support Coordinator submits a Change of Circumstances Form to the Agency. > > 22 Dec 2022 Mr Zekusic's Support Coordinator/Plan Manager notifies AIHCS as follows: "I have been advised by the NDIS that we need to withdraw the change of situation application and resubmit once an updated functional capacity assessment has been completed by an OT. I was advised that this is essential for the Home and Living panel to review the SIL funding.... I have sent this information to the Public Guardian and will be arranging an OT to complete the assessment as soon as I return from leave in January". > > 25 Jan 2023 Mr Zekusic's Support Coordinator notifies AIHCS of a delay in engaging an Occupational Therapist to carry out a functional capacity assessment due to waiting lists for these services. > > 6 Feb 2023 Mr Zekusic's Support Coordinator notifies AIHCS that the Public Guardian has consented to a named Occupational Therapy provider conducting a functional capacity assessment. > > 26 April 2023 AIHCS writes to Support Coordinator requesting action as follows: > > "Can we please get the review done ASAP. Mark's funds ran out in February and the review was supposed to be done after the OT Report. We are still doing 1:1 support without any payments for months. This will be to be included in the review and payments backdated too...." > > and in a separate email of same date (in part): > > "Moving forward, we need to ensure this is actioned asap as Mark's funding has been depleted. > > As Sarah mentioned the Occupational Therapists report you arranged was in February we are still awaiting on the report and the review from the Benevolent Society ...." > > 1 Nov 2023 AIHCS submitted three invoices to the Plan Manager totalling $174,149.32 in respect of support services provided to Mr Zekusic requiring their payment. > > 2 Nov 2023 Mr Wallace, on behalf of AIHCS, makes a complaint to the Commonwealth Ombudsman regarding the Agency's failure to pay debts allegedly owed to AIHCS for support services provided to several participants, including Mr Zekusic. > > 13 Nov 2023 AIHCS provided the Support Coordinator with a yearly budget for Mr Zekusic's support which relevantly included 1:1 intensity disability support worker support.[3] > > 17 Jan 2024 Mr Wallace, as Director of AIHCS, made a complaint to the NDIS Quality and Safeguards Commission regarding "unpaid debts" said to be owed in relation to several participants, including Mr Zekusic. > > 15 Feb 2024 Mr Wallace submitted a complaint to the Agency on behalf of AIHCS about the Agency's failure to pay alleged debts owed in respect of several participants, including Mr Zekusic in relation to whom it was asserted that $233,164.92 was owed. > > 19 Feb 2024 Mr Wallace, as Director of AIHCS, wrote to the Minister responsible for the NDIS to complain about amounts claimed to be owed to it by the NDIA in respect of several clients including the Mr Zekusic. > > 26 Feb 2024 the Agency's Claims and Payment Team notified Mr Wallace of the outcome of its review of AIHCS's claim for payment of invoices for Mr Zekusic totalling $233,164.92, advising (in part): > > "Your claim has been reviewed and we are unable to make the requested payment as the level of support that was provided is above the level that the delegate determined to be reasonable and necessary. > > ... > > Please resubmit these outstanding invoices for consideration if the participant has a home and living reassessment completed determining that they require 1:1 supports. When the participant's circumstances have changed and current supports are not meeting the participant's needs, the Agency may conduct a plan reassessment. Please contact the participant or contact us ... to discuss the plan reassessment process. > > This Payment Enquiry is now closed." > > 29 Feb - 5 Mar 2024 Mr Zekusic's Support Coordinator attempted to contact the Agency to discuss payment of AIHCS invoices, but was unable to do so because the Agency did not accept she had authority to do so. > > 5 Mar 2024 Mr Zekusic's Public Guardian contacted the Agency stating as follows: > > "Please find attached a letter from our office in support of an upcoming change of situation request, and a separate request to resolve the issue of pending invoices. > > Ms Kaur is Mr Zekusic's NDIS Coordinator of Support and has previously contacted the NDIA/NDIS to resolve the issue of pending invoices and this matter remains unresolved on the NDIS side." > > 8 Mar 2024 the Agency responded to Mr Wallace's complaints to the Minister responsible for the NDIS about debts allegedly owed to AIHCS, including in relation to Mr Zekusic, advising that AIHCS's claim for payment of invoices totalling $233,164.92 "have not been paid as they are not in accordance with the participant's plan and the funding determined reasonable and necessary by the planner delegate". > > 7 Mar 2024 Mr Zekusic's Support Coordinator notified AIHCS that she has submitted a request to the Agency for an unscheduled review of Mr Zekusic's participant plan and for one-off payment of AIHCS's pending invoices in relation to his support. > > 10 April 2024 Mr Zekusic's Support Coordinator notifies AIHCS that she had been contacting the Agency every two days to follow up her requests for an unscheduled plan review and for payment of AIHCS's invoices but has been told that there is a backlog, and a response will take at least 28 days. > > 17 June 2024 AIHCS sent an email to the Support Coordinator and Public Guardian requesting an "urgent review". That email states in part: > > "Thanks for organising the new plan. Unfortunately, most of the funds have been exhausted with back payments. I have attached the invoices, which have been sent through Proda for payment. Can we please organise an emergency review to get more funds, especially since his plan wasn't increased even though he requires 1:1 support? > > 1 Jul 2024 the Agency initiated an unscheduled review (s 48 reassessment) of Mr Zekusic's Participant Plan. > > 2 Jul 2024 the Agency issued a Notice of payment suspension to AIHCS in relation to Mr Zekusic's plan. That Notice stated (in part): > > "The National Disability Insurance Agency (NDIA) conducts reviews of provider claims to ensure the NDIS and participant plans remain financially sustainable. > > A review has been conducted on the claims submitted which identified claiming that is not in accordance with the participant's plan. > > ... > > This means that all payment requests will need to be manually assessed prior to being paid. > > To receive further payments, you will need to submit your payment request via the Provider Portal and email your supporting document to [payment integrity review email] > > ..." > > 5 Jul 2024 the delegate of the CEO approved a new SoPS for incorporation into a Participant Plan for Mr Zekusic which was expressed to commence on 5 July 2024, and which had a review date of 5 July 2025. > > 6,12,23 Sept 2024 Mr Wallace contacted the Agency to complain that AIHCS had not been paid invoices related to Mr Zekusic's support for the past 11 weeks because of the payment suspension and otherwise. > > 18 Oct 2024 the Agency's Payment Integrity Team wrote to Mr Wallace in response to his complaints stating, relevantly: > > "In the best interests of the Participant, we have afforded the opportunity to provide information for case claim numbers [set out] > > Please find attached ... Request for Information documents sent on 20th August 2024 and 30th August 2024 respectively that document the current claims under review.
If you do not respond by this date ... the decision made 23rd September 2024 to cancel payments relating to [claim number] will remain and will not be reviewed again by our team. > > An outcome decision letter will also be provided for both [other claims] if supporting information is provided by this date. > > In relation to the payments prior to the payments under review by our team in [claim numbers]. These were cancelled by the claims and payment team and further enquiries should be directed to that team. > > 18 Oct 2024 Mr Wallace submitted this application to the ART. > > 31 Oct 2024 In response to the Agency's Payment Integrity Team's email of 18 Oct 2024, Mr Wallace sent an email to that Team and others requesting an urgent meeting claiming, among other things, that AIHCS was owed $190,000 for Mr Zekusic's support over the previous 16 weeks it was not able to bill for these services. > > 5 Dec 2024 Mr Wallace completed and submitted to the Agency a standard form Agency "request for a review of a decision". In that request Mr Zekusic is named as the Applicant with Mr Wallace as his representative. In the section of the form that asks "what decision do you want to review?" Mr Wallace states "[participant no.] interim plan dates 6th Feb 2023 - 8th June 2023, 6th April 2024 - 5th July 2024". In the section of the form that asks "what decision were you expecting?" Mr Wallace states "when Mark first came into our care, it was told by the guardianship board and the Hospital and his support coordinator at the benevolence society that Mark was 1:1 funding. His psychologist advised he was 1:1 also. ... AIHCS contacted the benevolence society multiple times for a review, which they never completed and the support coordinator left and the new coordinator processed the review."
Date Event > > 24 Jan 2022 delegate of the CEO approves a SoPS in a Participant Plan expressed to commence from 24 January 2022, which has a review date of 24 January 2023. > > 18 Oct 2022 Mr Attalla's Support Coordinator, Ms Hopkins, submits a request to the Agency for a s 48 reassessment of his Participant Plan on the ground that Mr Fakhri Attalla, primary carer, was scheduled to undergo surgery. > > 22 Dec 2022 Ms Hopkins contacted the Agency to enquire about the status of the s 48 reassessment request made on 18 October 2022 stating urgency due to funding exhaustion. > > 23 Dec 2022 delegate of the CEO approves a new SoPS in a Participant Plan which is expressed to commence from 23 December 2022, which has a review date of 23 December 2023. > > 12 Sept 2023 delegate of the CEO extends the period of the plan (the details of the extension are not in evidence) > > 2 Nov 2023 Mr Wallace, as Director of AIHCS, made a complaint to the Commonwealth Ombudsman concerning the Agency's refusal or failure to pay debts said to be owed to AIHCS in relation to several participants, including Mr Attalla, > > 24 Nov 2023 a s 48 reassessment request is submitted to the Agency on behalf of Mr Attalla (the evidence before me does not disclose who made this request). > > 14 Dec 2023 delegate of the CEO approves a new SoPS in a Participant Plan which is expressed to commence on 14 December 2023, which has a review date of 14 December 2024. > > 19 Feb 2024 Mr Wallace, as Director of AIHCS, wrote to the Minister responsible for the NDIS to complain about amounts claimed to be owed to it by the NDIA in respect of several clients including Mr Attalla. > > 28 Feb 2024 a delegate of the Agency notified AIHCS that the amounts claimed by it in relation to Mr Attalla were not considered payable because it was more than the funding that had been approved under his SOPS. > > 6 Mar 2024 a delegate of the Agency notified Mr Wallace of the action taken in relation to his claims for payment of amounts in respect of several clients, including Mr Attalla. Mr Wallace was advised that his "claims [had] been reviewed for each participant and the outcomes were emailed to [him]... This Claim and Payment Enquiry is now closed." > > 8 Mar 2024 a delegate of the CEO responded to Mr Wallace's complaint to the Minister. With respect to Mr Attalla the delegate stated that as Mr Attalla's Participant Plan was Plan Managed enquiries had been made of the Plan Manager and Mr Wallace should discuss his claims with the Plan Manager. > > 13 May 2024 Mr Wallace, as purported representative of Mr Attalla, filed AAT application no.2024/3268 on an AAT standard application form, naming Mr Attalla as the applicant. In the section of the form which requires the applicant to identify the decision sought to be reviewed, Mr Wallace uploaded two communications to him from the Agency dated 28 February 2024 and 4 March 2024, which stated as follows: > > 28 Feb 24 > > "Dear Pascal, > > This correspondence is in relation to your Payment Enquiry [ no.] Participant Abanoub Attalla [participant no.] [5 invoice no.s set out] > > The National Disability Insurance Agency (NDIA) is required to make payment to a Plan Manager where the funding for a support is included in the Participant's Plan as Plan Managed, it cannot pay Providers directly. > > I emailed the outcome of this payment enquiry to the participant's current Plan Manager APOIO Group Pty Ltd on 28 February 2024, ... Please contact the plan manager directly for the outcome of this inquiry, when a plan manager is engaged, they are responsible for monitoring the plan budget, claiming and facilitating provider payments. They should also submit a Payment Enquiry on behalf of providers if they have issues claiming through the portal, or where the business system has reduced funding due to a plan reassessment occurring. > > This payment enquiry is now closed." > > 6 Mar 2024 > > [annotation by Mr Wallace "update to previous response with new invoices added - outcome remains unchanged"] > > "Dear Pascal > > This correspondence is in relation to your Payment Enquiry [no.] Participant Abanoub Attalla [Participant no.] [10 invoice no.s] total $197,179.43. > > The National Disability Insurance Agency (NDIA) is required to make payment to a Plan Manager where the funding for a support included in the Participant's Plan as Plan Managed. It cannot pay providers directly. > > I emailed the outcome of this payment enquiry to the participant's current Plan Manager APOIO Group Pty Ltd on 28 February 20224, ... Please contact the plan manager directly for the outcome of this inquiry, when a plan manager is engaged, they are responsible for monitoring the plan budget, claiming and facilitating provider payments. They should also submit a Payment Enquiry on behalf of providers if they have issues claiming through the portal, or where the business system has reduced funding due to a plan reassessment occurring. > > This payment enquiry is now closed." > > In the section of the form that requests the applicant to explain the reasons for the application, Mr Wallace stated: > > "payment enquiry [no.] we are owed $197,179.43 for 6 weeks of service 1:1 while the planning team stuffed around and Attalla didn't have a plan or funding. > > Attalla has always been funded 1:1 and we required a slight increase from $850K per year, up to 950K per year or something like that. > > He is very high needs and complex. He has 1:1 service at all times and 2 carers for showers. > > Attalla is bedbound, Peg fed and would die within 1-2 days without care provided. The fact we ever need to apply to the AAT for this case is laughable. > > We have submitted 3 payment requests, the plan manager Apio ... has also submitted them and they just blanket deny them. > > It's as if the ndis are slow on purpose doing their reviews and then providers are punished for provided service during the gap period without service. > > In the case with high needs complex care client, of course the care is reasonable and necessary. > > We now in total are owed $1.5million from the ndis because of their inefficiencies. Its all the same reason too, high needs complex client requires an increase in funding, ndis are understaffed and take 2-3 months to do a review, then they refuse to pay the invoices or back date the plan. It is so clearly a cost saving measure implemented by the ndis in the last 18 months. It never used to be like this. > > All of these six clients are 1:1 complex care, they can't have a day without service. > > Attalla is end of life care now and his life expectancy is another 3-9 months due to severe MDN. He is in his late 20's. > > 10 May 2024 a delegate of the CEO varied the SoPS contained in Mr Attalla's Participant Plan, apparently to increase funding for supports. > > 25 June 2024 application no. 2024/3268 was listed for an Interlocutory Hearing (dismissal) at the request of the Agency. > > 26 June 2024 Mr Wallace, acting on behalf of AIHCS, withdrew application no. 2024/2825 and it was dismissed. > > 8 Jul 2024 on behalf of AIHCS Mr Wallace submitted to the NDIS a document with the title "formal request for review" purportedly on behalf of Mr Fakhri Atttalla requesting review of the Agency's refusal/failure to pay amounts claimed in relation to the "dates of gap in service" in 2022 and 2023. The text of that document is set out below: > > "Formal request for Review: NDIS Agency > > NDIS Client name: Abanoub Attalla > > ... > > Dates of gap in service and total amount required: > > 4/12/2022 - 22/12/2022 $43,494.98 > > 30/10/2023 - 13/12/2023 $157,970.16 > > Total owing: > > $201,465.14 > > I Fakhri Attalla, as the Authorised representative of Abanoub Attalla, formally request that the ndis agency allocate two separate interim plans between the dates listed above to help pay the debts that are owed to our service provider (AIHCS) for the times where there was a gap in his ndis plans. > > NDIS Agency continues to refuse to pay my provider of choice AIHCS for the gaps in service. My son Abanoub's needs increase every year and the plan dates make no sense, the service is reasonable and necessary because if he wasn't provided service for 1 day he would die. The planner chose arbitrary dates for new plans to begin instead of commencing plan the date funding was out. > > Over the last 8 years, my son continues to decline every single year. Planner are incorrectly assessing his situation based on how he was at the time and not based on how much he declines each year. The first year gap was only 3 weeks, then next gap was 8 weeks. This was because the original plans didn't allocate enough funding to allow for my son's declining health. > > The review submitted would have easily met the urgent criteria given the dire nature of Abanoub health being both non-verbal, bed bound, completely unable to move and with significant cognitive decline. The client is extremely high risk of bed sores and requires turning every 2 hours as he can't move at all 1-2 days without service and the client would pass away. The review was not acted upon in an urgent matter and the start date of the plan doesn't make any sense. > > THERE CAN NEVER BE A GAP IN SERVICE FOR A HIGH NEEDS COMPLEX CLIENT > > The NDIS failed in their duty to act within a timely matter to provide adequate NDIS funding at a time when Abanoub needed it most. There were clear and obvious changes in circumstances throughout the years 2020, 21, 22, 23, and 24 and this is clearly reflected in his increased needs and increased ndis package year on year. > > The $201,465.14 that is required can be made available through these options:
We can provide a mountain of documents outlining why this support was reasonable and necessary if required, or we can let common sense prevail and get on with caring for our ndis clients. > > From > > Fakhri Attalla (Authorised representative) > > Supported by > > Harleen Kaur (Support Coordinator) > > Pascal Wallace (Director, AIHCS)" > > 19 Jul 2024 on behalf of AIHCS Mr Wallace wrote to the Agency's enquires email address to request that the "planning team" create "2 separate interim plans" in relation to the 'gap in service' periods in 2022 and 2023 and not review Mr Attalla's then current plan, as Mr Fakhri Attalla had been recently advised would occur. > > 11 Nov 2024 Mr Attalla's Support Coordinator, Ms Kaur, submitted a request for a s 48 reassessment of Mr Attalla's Participant Plan for the purpose of obtaining approval for high-cost assistive technology (replacement hoist, bed, and an air comfort chair) > > 4 Dec 2024 Mr Attalla's Support Coordinator advised the Agency that the Mr Fakhri Attalla requested 'cancellation' of the review requested by Mr Wallace in July 2024 > > 24 Dec 2024 delegate of the CEO approves a new SoPS in a Participant Plan which is expressed to commence on 24 December 2024, with a review date 23 December 2025.
I was working as the NDIS Coordinator for the NDIS Participant, Abanoub Attalla for the NDIS Plan period 2021-2022. I placed the Change of Circumstances for his NDIS plan as funds had exhausted. > > Once a new plan was issued, I placed a Provider payment request for the Providers whom had not ceased services due to the extremely high risk of death to the participant on Wednesday 4 February 2023 (Please see attached Appendix A). This was sent through along with the invoices from the Provider AIHCS (Workers Web Pty Ltd (please see attached Appendix B, C & D). I received a notice of receipt from the NDIS on 4 January 2023 (please see attached Appendix E). > > In the last week of February 2023, I received a call from the Provider Payments department within the NDIA. I recall the conversation I had with the lady about the outstanding funds from the exhausted plan for services completed which I submitted previously. The lady made a statement that as some of the funds on one invoice had been paid, she required that invoice to be updated to show the amount owing and the payments could be processed. > > Due to unforeseen circumstances, I ceased employment with that on 2 March 2023. > > In September 2023 I recommenced working as Support Coordinator to Abanoub Attalla and assist and support the participant and nominee to submit a change of circumstances as funds were nearing exhaustion. > > After gathering all supporting documentation, the paperwork was originally submitted to NDIS enquiries on 10/11/2024 and accepted on 24/11/2024 (please see appendix F) > > The Nominee and myself would call the NDIS every 2 days to see and track the progression of the submission. It was explained in each phone call to the representative that the provider trading as AIHCS were still providing the level of care to the participant and increasing amount owed for services provided were stated within each call. It was also stated to the representative that the risk in stopping services would cause Death by both myself and the nominee. > > At no time during the multiple phone calls made was I instructed that the services needed to be stopped and that the amount owing for continued services would not be paid.
100 Review of reviewable decisions > > (1) The decision-maker of a reviewable decision must give written notice of the reviewable decision, and of the reasons for the reviewable decision, to each person directly affected by the reviewable decision. > > ... > > (2) A person who is directly affected by a reviewable decision may request the decision-maker to review the reviewable decision. If the person is given a notice under subsection (1) the person must make the request within 3 months after receiving the notice. > > (3) A request may be made by:
(a) sending or delivering a written request to the decision-maker; or
(b) making an oral request, in person or by telephone or other means, to the decision-maker.
(4) If a person makes an oral request in accordance with paragraph (3)(b), the person receiving the oral request must:
(a) make a written record of the details of the request; and
(b) note on the record the day the request is made.
(5) If:
(a) the decision-maker receives a request for review of a reviewable decision; or
(b) the decision-maker is taken to have made a reviewable decision because of subsection 21(3), 47A(5) or 48(4);
the decision-maker (the reviewer) must review the reviewable decision
...
(6) The reviewer must make a decision:
(a) confirming the reviewable decision; or
(b) varying the reviewable decision; or
(c) setting aside the reviewable decision and substituting a new decision.
(6A) The reviewer must make the decision under subsection (6):
(a) within the period worked out in accordance with the National Disability Insurance Scheme rules prescribed for the purposes of this paragraph; or
(b) If there are no such rules - within the period of 90 days beginning on:
(i) If paragraph (5)(a) applies - the day the request is received; or
(ii) If paragraph (5)(b) applies - the day after the end of the period applicable under paragraph 21(3)(a) or (b) or subsection 47A(5) or 48(4) (as appropriate)
...
(8) A failure of the decision-maker to comply with subsection (1) does not affect the validity of the reviewable decision or the right of a person directly affected to request review of the decision.
The application naming Mr Attalla as applicant
Application no.s 2024/9251, 2024/9181 and 2024/8760 are each dismissed pursuant to 101(1)(a) and (c) of the Administrative Review Tribunal Act 2024 (Cth) on the grounds that they misconceived and are otherwise an abuse of process.
Date(s) of hearing: 11 February 2025, then heard on the papers.
[1] This debt is asserted in a letter to AIHCS from its auditor dated 7 February 2025. However, the claims made in relation the 3 named applicants appear to add to approximately $1,040,000.00 ($87,471,86 in respect of the Late Mr Pizzini, $751,000.00 in respect of Mr Zekusic, and $201,465.14 in respect of Mr Attalla), so the debt claimed does not appear to be only referable to support provided to them.
[2] On the state of the evidence, I am unable to know if this increased intensity was proposed for the whole day (24 hours) or for particular periods, including whether it included active overnight support.
[4] Gaudron and National Disability Insurance Agency [2021] AATA 615.
[6] An 'NDIS amount' is defined in s 9 of the NDIS Act to mean 'an amount paid under the National Disability Insurance Scheme in respect of supports (other than general supports) funded under a participant's plan.
[7] Carroll and National Disability Insurance Agency [2022] AATA 2822 at [12] (but note that the Tribunal there was dealing with an access request).
[8] Jones and National Disability Insurance Agency [2023] AATA 2014 at [10] - [12].
[9] Pascu and National Disability Insurance Agency (NDIS) [2025 ARTA 32.
[10] Ibid [at 33]. The Tribunal accepted there that the participant's statutory entitlement did not devolve upon their death, but also accepted that another person may have a relevant interest in continuing an existing substantive application before the Tribunal where there were accrued liabilities.
[11] I find some support for that conclusion in s 84(2)(a) of the ART Act which provides, in relation to an application that is already before the Tribunal at the time of an applicant's death, that an executor may apply to continue with that application. The section does not appear to require the executor to be joined as a separate party, only to obtain permission to 'continue' with the application. Section 84 is not presently relevant as Mr Pizzini had no application before the Tribunal at the time of his death.
[12] Deacon and National Disability Insurance Agency [2022] AATA 3209.
[13] s 3(1)(e) of the Objects of the NDIS Act; see also s 31(b) and (g).
[14] s 33 of the NDIS Act; QDKH, by his litigation representative BGJF v National Disability Insurance Agency [2021] FCAFC 189 at [7d].
[15] Complete Nursing and Home Care Pty Ltd and National Disability Insurance Scheme [2020] AATA 360 at [16]; Nganana Incorporated and National Disability Insurance Agency [2023] AATA 2906; LinkAssist Pty Ltd and National Disability Insurance Agency [2023] AATA 2063; 13 Homecare and National Disability Insurance Agency [2023] AATA 793; Glasshouse Community Supports Pty Ltd [2024] AATA 816.
[16] PTJR and CEO, National Disability Insurance Agency [2025] ARTA 196 at [49].
[17] Financial sustainability must be given regard within the operation of the NDIS Act: s 3(3)(b) and s 4(17) of the NDIS Act.
[18] National Disability Insurance Scheme (Supports for Participants) Rules 2013.