Dear ACC,

Under the Official Information Act 1982, I request the following information relating to ACC’s management of provider billing integrity, audit processes, and fraud-detection systems for the period 1 January 2019 – 31 December 2025 (or the closest period for which data is held):

1. Provider Audits and Billing Irregularities

1.1 The total number of provider audits conducted by ACC relating to unusual, irregular, or potentially non-compliant billing.

1.2 The number of providers investigated for any of the following categories of billing concern (aggregate numbers only):

services billed but not provided

inflated treatment duration

duplicate billing

retrospective amendments to treatment notes

billing inconsistent with ACC service schedules

any other identified billing anomalies

1.3 The number of these investigations where billing irregularities, overcharging, or fraud were substantiated.

2. Outcomes and Recoveries

2.1 The total amount recovered by ACC from providers (annual figures), broken down into:

overpayments

overbilling

fraudulent claims

audit adjustments

voluntary repayments after audit findings

(If already held in a consolidated internal report, providing that report would satisfy this request.)

2.2 The number of providers who:

were subject to corrective action plans

were suspended from delivering services

had contracts terminated

were referred to Police, Serious Fraud Office, or other regulatory bodies

3. Categories of Providers

3.1 For analysis and public transparency purposes, please provide high-level categories (not names) of provider types that have been the most frequently identified with billing irregularities from 2019–2025.

Examples may include:
physiotherapy, chiropractic, pain management, vocational rehabilitation, occupational therapy, radiology, specialist assessment providers, etc.

I am not requesting individual provider identification.

4. Fraud-Detection Framework and Audit Thresholds

4.1 Copies of any internal ACC documents that outline:

fraud-detection methodology

billing-anomaly detection rules

red-flag indicators

audit thresholds

internal referral pathways for suspected provider misconduct

monitoring or performance-assurance procedures used by ACC to detect potential irregularities

If documents are extensive, a list or summary index of relevant documents is sufficient.

Format

I request the above information in electronic form (Excel, PDF, or existing internal report formats).

If any part of the request is likely to require refinement, please advise so I may adjust the scope.

Thank you for your time.

Kind regards,
Spencer Jones