The Veterans Affairs Canada Health Care Benefits Program provides eligible Veterans and other qualified individuals with benefits and services, such as medical, surgical and dental care, prosthetic devices and home adaptations, through 14 Programs of Choice. Under the Veterans Health Care Regulations and Canadian Forces Members and Veterans Re-establishment and Compensation Act, eligible Veterans and other qualified individuals have access to benefits and services, such as medical, surgical and dental care, prosthetic devices and home adaptations. Related Health Services are services provided by health care professionals other than physicians, dentists and nurses. Examples of these types of services include occupational therapy, physiotherapy, massage therapy, chiropractic, acupuncture, speech language pathology and psychological counseling. The objective of this audit was to assess Veterans Affairs Canada’s management control framework, and compliance with applicable policies and processes, and to identify any potential opportunities to improve efficiency of decision making for Related Health Services. The scope covered transactions processed from April 1, 2012 to March 31, 2013.

The evaluation of the Financial Benefits Program was conducted in accordance with the Veterans Affairs Canada Multi-Year Risk-Based Evaluation Plan 2014-19. The program was last evaluated as part of an overall New Veterans Charter Evaluation in 2010-11. The Financial Benefits Program was established in 2006 under the authority of the Canadian Forces Members and Veterans Re-establishment and Compensation Act, with subsequent amendments expanding eligibility and adding programs. It provides economic support to eligible Canadian Armed Forces Veterans, survivors, and dependents in recognition of the economic impact that a career ending and/or service-related injury or death can have on a Veteran’s ability to earn income, advance in a career or save for retirement. As per Treasury Board Secretariat policy requirements and guidance, this evaluation examined the Financial Benefits Program’s relevance and performance. The evaluation findings and conclusions are based on the analysis of multiple lines of qualitative and quantitative evidence.

Since 1981, Veterans Affairs Canada has administered a community-based, national program to eligible Veterans, their families, and other primary care-givers. These services include home care, home adaptations, ambulatory health care, and intermediate nursing home care. Now known as the Veterans Independence Program, it offers self-managed care in co-operation with provinces and regional health authorities. The program allows eligible Veterans, their families, and other primary care-givers to focus on maintaining their health, independence, and their quality of life. Every effort is being made to integrate the Veterans Independence Program administration with provincial and local resources to ensure a cost-efficient choice of service is available and to avoid duplication of service delivery. Veterans Affairs Canada is responsible for setting up and amending the contribution arrangements while an external Contractor, Medavie Blue Cross, is responsible for processing the claims. In the Spring of 2011, Senior Management requested an audit of the Veterans Independence Program reimbursement process to identify opportunities to further improve the process. This audit builds off the results of a 2010 audit of Veterans Independence Program and is focused on a single objective to assess the efficiency and effectiveness of the reimbursement process. The scope covered the period from November 2010 to April 2011.

In 2012, Veterans Affairs Canada (VAC) and Service Canada entered into a Partnership whereby Service Canada would use their web, in-person and telephone services to provide general information on VAC’s benefits and services to individuals who visit Service Canada’s website, visit a Service Canada Centre or call VAC’s toll-free line. In addition, Service Canada would accept and review applications for the Disability Benefits Program and the Veterans Independence Program (VIP). The intention of the Partnership was that Veterans would have broader access to VAC’s services on the web, in-person and on the phone. By having Service Canada answer general inquiries on VAC’s behalf, it was expected that VAC would be able to re-focus their resources on more complex cases. The Partnership was also intended to increase points of access for VAC Services, particularly for residents in rural and remote areas. In addition, Service Canada would use their expertise and experience with all Government of Canada programs and bundle VAC’s information with a broader array of related Government of Canada programs and services. In February 2014 the Partnership was expanded to include employee hosting services, whereby Service Canada would provide office and meeting space for a VAC representative to be co-located in the Service Canada Centre closest to each of the VAC area offices that were closing. As part of the approval of the Partnership, an evaluation was required which would assess whether applicable service standards for Veterans had improved, whether resources were effectively refocused on improving case management and if efficiencies had materialized that could provide longer term operational savings without reducing the level of service to Veterans. The evaluation would also determine if there was compliance with the documented agreement between VAC and Service Canada, and identify any areas for improvement.

The evaluation of the Disability Benefits program was conducted in accordance with the Veterans Affairs Canada (VAC) Multi-Year Risk-Based Evaluation Plan 2014–19. The objective of the Disability Benefits program is to compensate Veterans/members and other individuals in recognition of the effects of service-related disabilities, death or incarceration/evasion/escape. The Disability Benefits program consists of both the Disability Pension and the Disability Award. The Pension Act of 1919 provides the framework for the Disability Pension (DP) which is a tax-free monthly payment, with the amount of the payment based on the extent of the Veteran's diagnosed medical disability related to their service. The Disability Award (DA), established in 2006 as part of the New Veterans Charter (NVC), provides injured members and Veterans with a tax-free cash award for an injury or illness resulting from military service. The amount of the award will depend on the severity of the disability. The Disability Benefits program provides a gateway to other VAC programs, services and benefits.

The Federal Health Claims Processing System is the automated system that processes health claims for Veterans Affairs Canada, the Department of National Defence and the Royal Canadian Mounted Police. To administer this large and complex system, Public Works and Government Services Canada contracts the services of a private health insurer, Medavie Blue Cross. Of the three departments, Veterans Affairs Canada is the largest user accounting for 87% of the total volume of claims processed. In 2010/11, there were 13.5 million claims processed for Veterans Affairs Canada at a value of $640 million. To protect the financial integrity of the claims processed, Medavie Blue Cross is contractually obligated to conduct investigative services of the 170,000 health care providers registered to deliver benefits or services to Veterans. The National Investigative Unit, within Medavie Blue Cross, conducts various audit activities to ensure that the health care providers are complying with the requirements. These activities include: * analyzing claims data to identify providers whose billing practices may not comply with the requirements; * distributing letters to Veterans to verify that benefits and services billed were actually received; * mail audits requesting providers to submit additional documentation to support a claim submitted; and * on-site audits where investigators will travel to the health care provider's business to meet with the staff and review the supporting documentation on location. The purpose of these audit activities is to identify potential recoveries, educate health care providers on the billing requirements and act as deterrent to improper billing practices.

The Veterans Affairs Canada Health Care Benefits Program provides eligible Veterans and other qualified individuals with benefits and services, such as medical, surgical and dental care, prosthetic devices and home adaptations, through 14 Programs of Choice. Program of Choice 13 – Special Equipment – includes any device or aid which is designed to enable the user to cope with the effects of a disease, disorder or injury, by facilitating medical stabilization, assisting in the performance of activities of daily living and restoring their function. Examples include emergency call devices, wheelchairs, walkers, power mobility devices, transfer/lift devices, and ergonomic equipment. The objective of this audit was to assess Veterans Affairs Canada’s management control framework and compliance with applicable policies and processes. The scope covered April 1, 2012, to March 31, 2013.

In the approved 2008-2011 Audit and Evaluation Plan, Veterans Affairs Canada (VAC) identified the Residential Care Program at Camp Hill Veterans Memorial Building (CHVMB) for audit. The Chief Audit Executive of VAC engaged Audit Services Canada (ASC) to plan and conduct the audit. CHVMB is a part of the Queen Elizabeth II Health Sciences Centre under the Capital District Health Authority (CDHA) of the Province of Nova Scotia. It is the largest Veterans facility in the Atlantic Region providing, under contract with VAC, long-term beds on a priority access basis to eligible Veterans under VACs Residential Care Program. This audit focused on VACs controls to manage CDHAs delivery of the Residential Care Program at CHVMB.

The Career Transition Services (CTS) Program evaluation was conducted in accordance with Veterans Affairs Canada’s (VAC) approved Multi-Year Risk-Based Evaluation Plan 2012-17. The Terms and Conditions of CTS were valid until March 31, 2016. The Career Transition Services Program was established in 2006 under the authority of the Canadian Forces Members and Veterans Re-establishment and Compensation Act. Policies and practices have been modified over the years but its essential mission has remained unchanged; i.e., to provide eligible Veterans and survivors with practical help finding a job as they transition from military to civilian life. CTS reimburses costs for services such as career counselling, job-search training and job-finding assistance for eligible Veterans and survivors to a lifetime maximum of $1,000 (including tax). The current program design differs from that originally established in 2006 with respect to eligibility, dollar limits and service providers. The evaluation examined the relevance and performance of the Career Transition Services Program, and was conducted in accordance with Treasury Board of Canada Secretariat (TBS) policy requirements and related TBS guidance. The evaluation findings and conclusions are based on the analysis of multiple lines of qualitative and quantitative evidence.

The purpose of the Veterans Independence Program (VIP) is to assist recipients in maintaining their independence through the provision of home and community care. As per the VIP Terms and Conditions, Veterans and other recipients in receipt of funding for VIP services must be contacted at least once annually to confirm the benefits are meeting the recipient’s needs. In January 2013, Canada Post, Public Works and Government Services Canada (PWGSC) and a third-party contractor became part of the Annual Follow-up and Survivor Renewal process. The objective of the audit was to assess the management control framework, the compliance with applicable policies and processes, and determine performance against the Annual Follow Up and Survivor Renewal service standard. The scope of this audit included all VIP Veterans and survivors due for follow-up or renewal between May 1, 2014 and September 30, 2014.