Request for Information on Provider Billing Irregularities, Audit Processes, and Fraud Controls (2019–2025)

SPENCER JONES made this Official Information request to Accident Compensation Corporation

Currently waiting for a response from Accident Compensation Corporation, they must respond promptly and normally no later than (details and exceptions).

From: SPENCER JONES

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

Link to this

SPENCER JONES left an annotation ()

This OIA forms part of a wider public-interest effort to understand how ACC monitors the integrity of billing across the large network of treatment providers, contractors, and rehabilitation suppliers it funds.

ACC spends hundreds of millions of dollars each year on external providers, so the public has a legitimate interest in knowing:

how irregular or non-compliant billing is identified

how often audits occur

how many cases are substantiated

how much money is recovered

what systems ACC uses to detect inappropriate billing practices

This request does not seek names of providers or any personal data.
It only asks for aggregate data, categories, policies, and oversight mechanisms, all of which should already be held inside ACC’s audit and fraud-prevention systems.

The goal is to provide greater clarity on how ACC manages financial risk, ensures fair use of levy funds, and maintains quality and accountability across its contracted provider network.

Updates will be posted here once ACC responds.

Link to this

From: Government Services
Accident Compensation Corporation

Kia ora,

Thank you for contacting ACC’s Government Services inbox.

If your request falls within scope of the Official Information Act, we
will endeavour to respond as soon as possible, and no later than 20
working days after receipt of your request. If we are unable to respond
within the statutory timeframe, we will notify you of an extension.

 

Please note that during the holiday period there is a three-week period
where days are not counted as working days. This is from 25 December 2025
to 15 January 2026, inclusive. You can read more about this on the
Ombudsman website here: [1]Official Information requests over the
2025/2026 holiday period. 

 

The information you have requested may involve documents which contain the
names and contact details of individuals. Please let us know whether you
are seeking that information as part of your request. We may need to
consult before deciding whether we can release this information, and this
may take a bit more time. If we do not hear from you, we will assume that
you do not require it.

 

For more information about Official Information Act requests, please
visit: [2]Ombudsman New Zealand | Tari o te Kaitiaki Mana Tangata.

If your request relates to your claim, or you’d like more information
about lodging a claim, please contact ACC’s claims team at 0800 101 996
or [3][email address].

For personal information requests or privacy matters,
please visit [4]Request for personal information (acc.co.nz).

For general queries, please visit: [5]Contact us (acc.co.nz).

 

 

Ngâ mihi,

Government Services

PO Box 242 / Wellington 6011 / New Zealand / [6]www.acc.co.nz

ACC cares about the environment – please don’t print this email
unless it is really necessary. Thank you.

 

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

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From: Government Services
Accident Compensation Corporation


Attachment GOV 044915 Copy of requests.pdf
340K Download View as HTML

Attachment GOV 044915 Response.pdf
197K Download View as HTML

Attachment GOV 044915 COVID data.xlsx
19K Download View as HTML


Kia ora Spencer

 

Please find attached our response to 12 of your official information
requests dated between 5 and 14 December (our references: GOV-044915,
GOV-044929, GOV 044959, GOV-044985, GOV-044948, GOV-044950, GOV-044952,
GOV-044951, GOV-044947, GOV 044978, GOV-045041, and GOV-045119). 

 

If you have any questions about the response you can contact us at this
[1]address, for all other matters please use our contact form
at: [2]https://www.acc.co.nz/contact/ alternatively give us a call
on 0800 101 996.

If you are having trouble viewing the PDF, please ensure you have the
latest version of Adobe Acrobat Reader. To download this freeware please
click [3]here. 

 

Ngâ mihi
Christopher Johnston (he/him)
Manager | OIA Services

* PO Box 242, Wellington 6011

ACC cares about the environment – please don’t print this email unless it
is really necessary. Thank you.

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

References

Visible links
1. mailto:[email address]
2. https://www.acc.co.nz/contact/
3. https://get.adobe.com/nz/reader/

Link to this

From: Government Services
Accident Compensation Corporation


Attachment GOV 044915 Copy of requests.pdf
340K Download View as HTML

Attachment GOV 044915 Response.pdf
197K Download View as HTML

Attachment GOV 044915 COVID data.xlsx
19K Download View as HTML


Kia ora Spencer

 

Please find attached our response to 12 of your official information
requests dated between 5 and 14 December (our references: GOV-044915,
GOV-044929, GOV 044959, GOV-044985, GOV-044948, GOV-044950, GOV-044952,
GOV-044951, GOV-044947, GOV 044978, GOV-045041, and GOV-045119). 

 

If you have any questions about the response you can contact us at this
[1]address, for all other matters please use our contact form
at: [2]https://www.acc.co.nz/contact/ alternatively give us a call
on 0800 101 996.

If you are having trouble viewing the PDF, please ensure you have the
latest version of Adobe Acrobat Reader. To download this freeware please
click [3]here. 

 

Ngâ mihi
Christopher Johnston (he/him)
Manager | OIA Services

* PO Box 242, Wellington 6011

ACC cares about the environment – please don’t print this email unless it
is really necessary. Thank you.

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

References

Visible links
1. mailto:[email address]
2. https://www.acc.co.nz/contact/
3. https://get.adobe.com/nz/reader/

Link to this

From: Government Services
Accident Compensation Corporation


Attachment GOV 044915 Copy of requests.pdf
340K Download View as HTML

Attachment GOV 044915 Response.pdf
197K Download View as HTML

Attachment GOV 044915 COVID data.xlsx
19K Download View as HTML


Kia ora Spencer

 

Please find attached our response to 12 of your official information
requests dated between 5 and 14 December (our references: GOV-044915,
GOV-044929, GOV 044959, GOV-044985, GOV-044948, GOV-044950, GOV-044952,
GOV-044951, GOV-044947, GOV 044978, GOV-045041, and GOV-045119). 

 

If you have any questions about the response you can contact us at this
[1]address, for all other matters please use our contact form
at: [2]https://www.acc.co.nz/contact/ alternatively give us a call
on 0800 101 996.

If you are having trouble viewing the PDF, please ensure you have the
latest version of Adobe Acrobat Reader. To download this freeware please
click [3]here. 

 

Ngâ mihi
Christopher Johnston (he/him)
Manager | OIA Services

* PO Box 242, Wellington 6011

ACC cares about the environment – please don’t print this email unless it
is really necessary. Thank you.

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

References

Visible links
1. mailto:[email address]
2. https://www.acc.co.nz/contact/
3. https://get.adobe.com/nz/reader/

Link to this

From: Government Services
Accident Compensation Corporation


Attachment GOV 044915 Copy of requests.pdf
340K Download View as HTML

Attachment GOV 044915 Response.pdf
197K Download View as HTML

Attachment GOV 044915 COVID data.xlsx
19K Download View as HTML


Kia ora Spencer

 

Please find attached our response to 12 of your official information
requests dated between 5 and 14 December (our references: GOV-044915,
GOV-044929, GOV 044959, GOV-044985, GOV-044948, GOV-044950, GOV-044952,
GOV-044951, GOV-044947, GOV 044978, GOV-045041, and GOV-045119). 

 

If you have any questions about the response you can contact us at this
[1]address, for all other matters please use our contact form
at: [2]https://www.acc.co.nz/contact/ alternatively give us a call
on 0800 101 996.

If you are having trouble viewing the PDF, please ensure you have the
latest version of Adobe Acrobat Reader. To download this freeware please
click [3]here. 

 

Ngâ mihi
Christopher Johnston (he/him)
Manager | OIA Services

* PO Box 242, Wellington 6011

ACC cares about the environment – please don’t print this email unless it
is really necessary. Thank you.

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

References

Visible links
1. mailto:[email address]
2. https://www.acc.co.nz/contact/
3. https://get.adobe.com/nz/reader/

Link to this

From: Government Services
Accident Compensation Corporation


Attachment GOV 044915 Copy of requests.pdf
340K Download View as HTML

Attachment GOV 044915 Response.pdf
197K Download View as HTML

Attachment GOV 044915 COVID data.xlsx
19K Download View as HTML


Kia ora Spencer

 

Please find attached our response to 12 of your official information
requests dated between 5 and 14 December (our references: GOV-044915,
GOV-044929, GOV 044959, GOV-044985, GOV-044948, GOV-044950, GOV-044952,
GOV-044951, GOV-044947, GOV 044978, GOV-045041, and GOV-045119). 

 

If you have any questions about the response you can contact us at this
[1]address, for all other matters please use our contact form
at: [2]https://www.acc.co.nz/contact/ alternatively give us a call
on 0800 101 996.

If you are having trouble viewing the PDF, please ensure you have the
latest version of Adobe Acrobat Reader. To download this freeware please
click [3]here. 

 

Ngâ mihi
Christopher Johnston (he/him)
Manager | OIA Services

* PO Box 242, Wellington 6011

ACC cares about the environment – please don’t print this email unless it
is really necessary. Thank you.

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

References

Visible links
1. mailto:[email address]
2. https://www.acc.co.nz/contact/
3. https://get.adobe.com/nz/reader/

Link to this

From: Government Services
Accident Compensation Corporation


Attachment GOV 044915 Copy of requests.pdf
340K Download View as HTML

Attachment GOV 044915 Response.pdf
197K Download View as HTML

Attachment GOV 044915 COVID data.xlsx
19K Download View as HTML


Kia ora Spencer

 

Please find attached our response to 12 of your official information
requests dated between 5 and 14 December (our references: GOV-044915,
GOV-044929, GOV 044959, GOV-044985, GOV-044948, GOV-044950, GOV-044952,
GOV-044951, GOV-044947, GOV 044978, GOV-045041, and GOV-045119). 

 

If you have any questions about the response you can contact us at this
[1]address, for all other matters please use our contact form
at: [2]https://www.acc.co.nz/contact/ alternatively give us a call
on 0800 101 996.

If you are having trouble viewing the PDF, please ensure you have the
latest version of Adobe Acrobat Reader. To download this freeware please
click [3]here. 

 

Ngâ mihi
Christopher Johnston (he/him)
Manager | OIA Services

* PO Box 242, Wellington 6011

ACC cares about the environment – please don’t print this email unless it
is really necessary. Thank you.

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

References

Visible links
1. mailto:[email address]
2. https://www.acc.co.nz/contact/
3. https://get.adobe.com/nz/reader/

Link to this

From: Government Services
Accident Compensation Corporation


Attachment GOV 044915 Copy of requests.pdf
340K Download View as HTML

Attachment GOV 044915 Response.pdf
197K Download View as HTML

Attachment GOV 044915 COVID data.xlsx
19K Download View as HTML


Kia ora Spencer

 

Please find attached our response to 12 of your official information
requests dated between 5 and 14 December (our references: GOV-044915,
GOV-044929, GOV 044959, GOV-044985, GOV-044948, GOV-044950, GOV-044952,
GOV-044951, GOV-044947, GOV 044978, GOV-045041, and GOV-045119). 

 

If you have any questions about the response you can contact us at this
[1]address, for all other matters please use our contact form
at: [2]https://www.acc.co.nz/contact/ alternatively give us a call
on 0800 101 996.

If you are having trouble viewing the PDF, please ensure you have the
latest version of Adobe Acrobat Reader. To download this freeware please
click [3]here. 

 

Ngâ mihi
Christopher Johnston (he/him)
Manager | OIA Services

* PO Box 242, Wellington 6011

ACC cares about the environment – please don’t print this email unless it
is really necessary. Thank you.

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

References

Visible links
1. mailto:[email address]
2. https://www.acc.co.nz/contact/
3. https://get.adobe.com/nz/reader/

Link to this

From: Government Services
Accident Compensation Corporation


Attachment GOV 044915 Copy of requests.pdf
340K Download View as HTML

Attachment GOV 044915 Response.pdf
197K Download View as HTML

Attachment GOV 044915 COVID data.xlsx
19K Download View as HTML


Kia ora Spencer

 

Please find attached our response to 12 of your official information
requests dated between 5 and 14 December (our references: GOV-044915,
GOV-044929, GOV 044959, GOV-044985, GOV-044948, GOV-044950, GOV-044952,
GOV-044951, GOV-044947, GOV 044978, GOV-045041, and GOV-045119). 

 

If you have any questions about the response you can contact us at this
[1]address, for all other matters please use our contact form
at: [2]https://www.acc.co.nz/contact/ alternatively give us a call
on 0800 101 996.

If you are having trouble viewing the PDF, please ensure you have the
latest version of Adobe Acrobat Reader. To download this freeware please
click [3]here. 

 

Ngâ mihi
Christopher Johnston (he/him)
Manager | OIA Services

* PO Box 242, Wellington 6011

ACC cares about the environment – please don’t print this email unless it
is really necessary. Thank you.

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

References

Visible links
1. mailto:[email address]
2. https://www.acc.co.nz/contact/
3. https://get.adobe.com/nz/reader/

Link to this

From: Government Services
Accident Compensation Corporation


Attachment GOV 044915 Copy of requests.pdf
340K Download View as HTML

Attachment GOV 044915 Response.pdf
197K Download View as HTML

Attachment GOV 044915 COVID data.xlsx
19K Download View as HTML


Kia ora Spencer

 

Please find attached our response to 12 of your official information
requests dated between 5 and 14 December (our references: GOV-044915,
GOV-044929, GOV 044959, GOV-044985, GOV-044948, GOV-044950, GOV-044952,
GOV-044951, GOV-044947, GOV 044978, GOV-045041, and GOV-045119). 

 

If you have any questions about the response you can contact us at this
[1]address, for all other matters please use our contact form
at: [2]https://www.acc.co.nz/contact/ alternatively give us a call
on 0800 101 996.

If you are having trouble viewing the PDF, please ensure you have the
latest version of Adobe Acrobat Reader. To download this freeware please
click [3]here. 

 

Ngâ mihi
Christopher Johnston (he/him)
Manager | OIA Services

* PO Box 242, Wellington 6011

ACC cares about the environment – please don’t print this email unless it
is really necessary. Thank you.

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

References

Visible links
1. mailto:[email address]
2. https://www.acc.co.nz/contact/
3. https://get.adobe.com/nz/reader/

Link to this

From: Government Services
Accident Compensation Corporation


Attachment GOV 044915 Copy of requests.pdf
340K Download View as HTML

Attachment GOV 044915 Response.pdf
197K Download View as HTML

Attachment GOV 044915 COVID data.xlsx
19K Download View as HTML


Kia ora Spencer

 

Please find attached our response to 12 of your official information
requests dated between 5 and 14 December (our references: GOV-044915,
GOV-044929, GOV 044959, GOV-044985, GOV-044948, GOV-044950, GOV-044952,
GOV-044951, GOV-044947, GOV 044978, GOV-045041, and GOV-045119). 

 

If you have any questions about the response you can contact us at this
[1]address, for all other matters please use our contact form
at: [2]https://www.acc.co.nz/contact/ alternatively give us a call
on 0800 101 996.

If you are having trouble viewing the PDF, please ensure you have the
latest version of Adobe Acrobat Reader. To download this freeware please
click [3]here. 

 

Ngâ mihi
Christopher Johnston (he/him)
Manager | OIA Services

* PO Box 242, Wellington 6011

ACC cares about the environment – please don’t print this email unless it
is really necessary. Thank you.

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

References

Visible links
1. mailto:[email address]
2. https://www.acc.co.nz/contact/
3. https://get.adobe.com/nz/reader/

Link to this

From: SPENCER JONES

Subject: Follow-up on FYI #33169 – Provider billing irregularities and fraud controls

Kia ora ACC OIA Services,

Thank you for your response dated 18 December 2025 (GOV-044915).

I do not consider that FYI #33169—my request concerning provider billing irregularities, audit activity, recoveries, and fraud-control frameworks—has been substantively answered.

This request sought high-level, aggregated information only, including annual totals for:
• provider audits relating to billing irregularities,
• substantiated overbilling or fraud findings,
• recovery amounts,
• enforcement outcomes (e.g. corrective action, suspension, referral), and
• the existence of fraud-detection and audit-threshold frameworks.

No individual provider identification, claim-level review, or new dataset creation was requested.

The response relies on a global refusal under s 18(f) by aggregating this OIA with 11 others on unrelated subjects. Respectfully, this does not address whether this specific request, assessed on its own merits, could be answered in part or with refinement.

Under section 13 (duty to assist), I ask ACC to:
1. Treat FYI #33169 as a stand-alone request, and
2. Advise what narrowing or staging would enable disclosure (for example:
• annual national totals only;
• a reduced timeframe; or
• confirmation of whether such summary reporting already exists).

ACC is a national insurer managing billions in public funds. Aggregate data on provider audits, recoveries, and fraud referrals would reasonably be expected to exist in some form for governance, assurance, or reporting purposes. If such information is genuinely not held, please confirm that explicitly for each major component of the request, rather than by bundled refusal.

I am willing to refine the scope promptly to facilitate a lawful and proportionate response.

Kind regards,
Spencer Jones

Link to this

SPENCER JONES left an annotation ()

Public Annotation – Provider Billing Integrity and Fraud Controls at ACC

This Official Information Act request sought transparency on how ACC detects, audits, and responds to provider billing irregularities and potential fraud between 2019 and 2025. Specifically, it asked for aggregated national-level information on:
• the number of provider audits,
• substantiated overbilling or fraud findings,
• recovery amounts,
• enforcement actions (e.g. suspension or referral), and
• the existence of fraud-detection and audit-threshold frameworks.

ACC did not provide this information.

Instead, ACC issued a blanket refusal under section 18(f) (“substantial collation and research”) by bundling this request together with 11 other, unrelated OIAs submitted around the same time. No item-by-item assessment of the billing-irregularities request was provided, and no attempt was made to offer partial disclosure, staged release, or narrowing options for this specific OIA.

The response did not state that:
• provider audit data does not exist, or
• recovery and fraud-control metrics are not tracked.

Rather, it declined to answer on workload grounds without engaging the duty to assist under section 13 of the Act.

This outcome raises legitimate public-interest questions. As a public insurer responsible for large volumes of provider payments, ACC would ordinarily be expected to maintain governance-level visibility over billing compliance, recoveries, and fraud risk—even if detailed datasets are complex.

The requester has sought clarification and offered to refine the scope so that high-level accountability information can be released without undue burden. Whether ACC engages constructively with that refinement will be relevant to any further oversight or Ombudsman review.

Link to this

From: Government Services
Accident Compensation Corporation

Kia ora,

Thank you for contacting ACC’s Government Services inbox.

If your request falls within scope of the Official Information Act, we
will endeavour to respond as soon as possible, and no later than 20
working days after receipt of your request. If we are unable to respond
within the statutory timeframe, we will notify you of an extension.

 

Please note that during the holiday period there is a three-week period
where days are not counted as working days. This is from 25 December 2025
to 15 January 2026, inclusive. You can read more about this on the
Ombudsman website here: [1]Official Information requests over the
2025/2026 holiday period. 

 

The information you have requested may involve documents which contain the
names and contact details of individuals. Please let us know whether you
are seeking that information as part of your request. We may need to
consult before deciding whether we can release this information, and this
may take a bit more time. If we do not hear from you, we will assume that
you do not require it.

 

For more information about Official Information Act requests, please
visit: [2]Ombudsman New Zealand | Tari o te Kaitiaki Mana Tangata.

If your request relates to your claim, or you’d like more information
about lodging a claim, please contact ACC’s claims team at 0800 101 996
or [3][email address].

For personal information requests or privacy matters,
please visit [4]Request for personal information (acc.co.nz).

For general queries, please visit: [5]Contact us (acc.co.nz).

 

 

Ngâ mihi,

Government Services

PO Box 242 / Wellington 6011 / New Zealand / [6]www.acc.co.nz

ACC cares about the environment – please don’t print this email
unless it is really necessary. Thank you.

 

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