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2.0 About The Audit

2.1 Audit Objectives

Currently, VAC is in the process of re-engineering the VIP program. In support of this initiative, in the Spring 2011, Senior Management requested an audit of the VIP reimbursement process to identify opportunities to further improve the process. This audit was recommended for approval by VAC’s Departmental Audit Committee (DAC) and subsequently approved by the Deputy Minister on April 13, 2011.

In 2010, an audit of the VIP was completed. The focus of the 2010 VIP audit was to assess compliance with legislation or policies, accuracy of payments and the quality assurance function. This audit of the VIP reimbursement process builds off the results of the 2010 audit with the single objective to assess the efficiency and effectiveness of the VIP reimbursement process.

2.2 Scope

This audit will assess the process for both Veteran and provider VIP reimbursements, excluding Intermediate Care. Intermediate Care was excluded because it is being covered by a separate audit of the Long Term Care Program which is currently in progress.

In November 2010, the delegated authorities relating to VIP were revised along with the associated roles and responsibilities for setting up a contribution arrangement in CSDN and FHCPS. As a result, this date was selected as the starting point for the scope of the audit. The scope consisted of claims processed during the period of November 1, 2010 to April 30, 2011.

2.3 Methodology

The audit was conducted in accordance with the Institute of Internal Auditors' (IIA) Standards for the Professional Practice of Internal Auditing, as required under the Treasury Board Policy on Internal Audit. To achieve the audit’s objectives, the following methodologies were used:

  • Interviews were held with employees at MBC, Contract Administration staff at VAC’s Head Office (HO), and program staff at VAC HO and in four district offices (DO) to gather an understanding of the current VIP reimbursement process as well as to gather necessary data for the audit.
  • Two VAC district offices and both of MBC’s offices were visited to observe, consult and confirm VIP processes.
  • A walkthrough was conducted with MBC staff to obtain an understanding of the VIP claim reimbursement process. This also enabled the audit team to assess efficiency and effectiveness of the process.
  • A statistical sample of 260 claims was reviewed. The sample was chosen from a population of 475,060 claims based on a 90% confidence interval and a 5% margin of error. This enabled the audit team to verify the accuracy of reported processing times, determine the percentage of claims that were taking longer than the standard, analyze claims referred to VAC, determine overall efficiency and make any necessary recommendations for changes.
  • A non-statistical sample of 50 claims referred to VAC during the month of May was reviewed to determine the processing times by VAC and MBC. It is important to note that historical information regarding claims referred to VAC is not stored meaning once the pending claim has been actioned any record is removed from the system.
  • Supportive documentation such as policies, procedures, directives and business processes were reviewed to determine that both MBC and VAC departmental policies and procedures result in VIP payments made in an efficient and effective manner.

2.4 Statement of assurance

In the professional judgment of the Chief Audit Executive, sufficient and appropriate audit procedures have been conducted and evidence gathered to support with a high level of assurance the accuracy of the audit opinion provided in this report. This audit opinion is based on a comparison of the situation at the time of the audit and the pre-established audit criteria that were agreed on with management. The audit opinion is only applicable to the entity, process and system examined. The evidence was gathered in compliance with Treasury Board policy, directives, and standards on internal audit and the procedures used meet the professional standards of the Institute of Internal Auditors. The evidence gathered is sufficient to provide senior management with a high level of assurance on the audit opinion.

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