As part of the ongoing monitoring and evaluation of service delivery, a cyclical audit was conducted to review the activities of the Quebec District Office (DO), the management control framework and the information used for decision making purposes. The Quebec DO was selected based on criteria set by senior management. The objectives of the 2009-2010 audit are: * Examine the application and implementation of new delegated authorities for Area Counsellors (ACs) (Fall 2009); * Verify the efficiency of the delivery of the rehabilitation program and the integrity of internal controls over its adjudication; * Verify internal controls over the award and delivery of Veterans Independence Program’s (VIP) home care services to Canadian Forces (CF) Veterans; * Assess the adequacy of the management control framework for long term care (i.e. oversight, functional direction, reporting and internal controls). The audit focussed primarily on the implementation of the new delegation of authority at the Quebec DO and on delivery of the Rehabilitation, VIP and Long Term Care (LTC) Programs.

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.

Veterans Affairs Canada (VAC) provides a wide range of health care benefits and services to eligible program recipients as specified under the authority of the Veterans Health Care Regulations. These entitlements are made available under the Treatment Benefits Program and Veterans Independence Program (VIP). The objective of these programs is to ensure program recipients are provided, according to their treatment eligibility, with reasonable and timely services that the Department considers to be an appropriate response to their assessed health needs. This audit was recommended for Deputy Minister approval by VAC’s Departmental Audit Committee on September 17, 2010. The objectives of the Federal Health Claims Processing System (FHCPS) Service Provider Audit were as follows: 1. To assess the adequacy of the service provider registration process; 2. To assess the adequacy of the requirements for service providers; 3. To determine compliance with service provider requirements; 4. To assess the efficiency of the appointment of service providers.

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.

Vocational Rehabilitation Services is a component of the Veterans Affairs Rehabilitation Program. It provides vocational assistance services and benefits to eligible Veterans who have a health problem, and their families, to assist them in their re-establishment to civilian life. Vocational services and benefits include vocational assessments, employability skills, training, career exploration, job placement and follow-up support. The purpose of the audit was to provide assurance that financial controls were working as intended, to deliver results in accordance with related authorities. This is the first audit of Vocational Rehabilitation since its inception in 2006.

The Long Term Care Program works in cooperation with provinces/territories, health authorities and long term care facilities to financially support eligible Veterans in an appropriate long term care setting. Veterans Affairs Canada provides funding for qualified Veterans who occupy a contract bed or those in a community bed. As of March 31, 2011, there were 9,376 recipients of funding support from Veterans Affairs Canada in non-departmental institutions across Canada. 2,782 recipients were in contract beds and 6,594 were in community beds. These numbers are forecasted to decline between 2012 and 2020 when there will be a decline in demand for Long Term Care. Forecasts estimate that there will be 5,780 Veterans in long term care in five years (2016-2017). The purpose of this audit was to provide assurance that the management control framework governing the Long Term Care Program is effective and the internal controls surrounding the program are adequate and functioning well. The scope included Long Term Care recipients in community beds and contract beds governed by a Memorandum of Understanding with provincial health authorities, from April 1, 2010 to March 31, 2011.

Healthcare professional service contractors are individuals with “significant training, qualifications and expertise in a professional field.” With the support of Public Works and Government Services Canada, these contractors are used to obtain expert knowledge and to complement the existing workforce. At Veterans Affairs Canada (VAC), these healthcare professional service contractors review or conduct assessments of Veterans' health needs for services or benefits as well as provide consultation with VAC staff. During the 2012/13 fiscal year, there were 55 healthcare professional service contracts for Occupational Therapists, Nurses, Doctors and a Dentist, excluding those at Ste. Anne’s Hospital. The purpose of the audit was to provide assurance that the departmental activities relating to healthcare professional service contracts were conducted in compliance with VAC procedures, and Treasury Board (TB) policies and regulations. Overall governance and the payment process were also assessed. Fieldwork was conducted from April to July 2013.

In 2011, Veterans Affairs Canada initiated a five-year Transformation Agenda to respond to the changing needs and expectations of the Veteran population. The goal was to fundamentally change how the Department delivers programs and services. The targeted efforts of the Department included overhauling service delivery, simplifying processes and cutting red tape for Veterans. To simplify the process for Veterans and expedite decision making, Veterans Affairs Canada case managers were given the responsibility to make medical/psychosocial decisions for Rehabilitation Program participants and to properly document these decisions. By delegating this new authority to the level closest to program recipients, case managers were expected to be more efficient and effective in responding to Veterans' needs and be more empowered in their position. To assist staff in making these decisions, the Department developed training courses for staff and introduced tools such as the six-step decision-making model. Recent internal audits have identified risks relating to the absence of quality assurance on decisions and the lack of supporting documentation on files. Veterans Affairs Canada must ensure that there are sufficient internal controls and that staff are complying with the directives of the Department when making decisions. Through interviews, documentation review, and an analysis of 120 sample files, this audit provides assurance that the delegated decision-making controls are working as intended to deliver planned results in accordance with related authorities.

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 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.