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 Audit of the Veterans Independence Program (VIP) was approved by the Departmental Audit Committee in 2009. The objectives of the audit were to determine if: 1. up-to-date policies and procedures were in place to support program delivery; 2. program payments were accurately calculated and paid to eligible clients and approved providers; 3. regulatory and policy requirements were complied with; and 4. the quality assurance function provides an ongoing assessment of compliance requirements and identifies opportunities for improvement.

Travel, Hospitality, Conference and Event activities are essential to the effective delivery of government services. At Veterans Affairs Canada, these activities can include: * a staff member travelling to a Veteran’s home to complete an assessment; * refreshments being provided to guests of the Department during a meeting; * health professionals attending a conference to discuss the latest developments in the field; or * a commemoration event celebrating the sacrifice of Veterans. Effective April 1, 2014, the Treasury Board Directive on Travel, Hospitality, Conference and Event Expenditures was updated with new requirements. The intent of these changes was to strengthen oversight and accountability to ensure sound fiscal management of public funds. The objective of this audit was to assess compliance with the Directive on Travel, Hospitality, Conference and Event Expenditures and ensure that the new changes had been properly implemented. Audit results confirmed that Veterans Affairs Canada was mostly compliant with the requirements of the Directive. There is one recommendation on ensuring the committing of funds are actioned in accordance with governing authorities. Overall, the audit team determined the results to be "Generally Acceptable".

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.

In January 2011, the Audit & Evaluation Division commenced a Risk Assessment of Information Management within the Department. The purpose of this Risk Assessment was to provide Senior Management with a comprehensive analysis of all aspects of information management within the Department to ensure that Veterans Affairs Canada had appropriately responded to all potential risks. A total of 14 entities relating to Information Management were analyzed utilizing risk assessment methodology developed by the Office of the Comptroller General.

This evaluation of the Health Care Benefits and Services Program was conducted in accordance with Veterans Affairs Canada's (VAC) approved multi-year, risk-based Evaluation Plan 2012-2017. The Health Care Benefits and Services Program, commonly referred to as the Treatment Benefits Program, provides Veteran recipients with access to extended health care. There are 14 benefits and services groups comprising a wide range of offerings. An overview of the benefits and services can be found in Appendix A. The evaluation examined the relevance and performance of the Program, and was conducted in accordance with Treasury Board policy requirements and related Treasury Board Secretariat guidance material. The evaluation findings and conclusions are based on the analysis of multiple lines of qualitative and quantitative evidence.

The Employee Compensation Audit was part of the 2009/2010 Veterans Affairs Canada Audit Plan approved by the Deputy Minister (DM). As part of the design process, a preliminary survey was conducted to determine the areas of pay that have the highest level of risk for the department. As a result, Regular pay, Overtime Pay and Acting Pay were included in the audit.

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.