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Executive Summary

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. As of March 31, 2011, there were 108,000 participants in the Veterans Independence Program and the total Veterans Independence Program expenditure for the fiscal year 2010-2011 was $338 million.

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. There were 475,060 transactions processed between December 2010 and April 2011. The expected turnaround time to process a claim is ten business days.

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.

Audit Opinion

In the opinion of the audit team, the Veterans Independence Program reimbursement process was determined to be generally acceptable. One issue with compliance was identified as well, there is a need to establish and communicate a service standard for claims referred to Veterans Affairs Canada for action. However, the audit results indicated that the reimbursement process was reasonably efficient and effective with 97% of transactions processed within 10 business days and there was an appropriate monitoring system in place.

Recommendations

Recommendation 1

It is recommended that the Director General, Service Delivery Management Division, ensure that staff processing Veterans Independence Program reimbursement claims understand what is required with regard to the documentation of decision making; as well as provide training on the functionalities of the Federal Health Claims Processing System. (Essential)

  1. Corrective action to be taken

    Complete the development of training materials on the process to document decision making and on the functionalities of the Federal Health Claims Processing System.

    OPI (Office of Primary Interest)

    Service Delivery Management

    Target date

    December 2011

  2. Corrective action to be taken

    Deliver training

    OPI (Office of Primary Interest)

    Service Delivery Management

    Target date

    March 2012

Recommendation 2

It is recommended that the Director General, Policy and Research Division, ensure that Veterans who receive the Veterans Independence Program benefits meet legislative eligibility requirements. (Critical)

  1. Corrective action to be taken

    Implement the new policy

    OPI (Office of Primary Interest)

    Program Policy

    Target date

    March 2012

Recommendation 3

It is recommended that the Director General, Service Delivery Management Division, clearly establish, document and communicate the service standards for claims referred to Veterans Affairs Canada for action. (Essential)

  1. Corrective action to be taken

    Review and ensure appropriate service standards are in place for the Veterans Independence Program

    OPI (Office of Primary Interest)

    Service Delivery Management

    Target date

    January 2012

  2. Corrective action to be taken

    Communicate service standards to staff

    OPI (Office of Primary Interest)

    Service Delivery Management

    Target date

    March 2012

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.

Orignal Signed By
Don Love
Chief Audit Executive

Date
October 3, 2011

  • The Audit Team consisted of:
  • Jonathan Adams, Audit & Evaluation Director
  • Bob Parsons, Audit & Evaluation Manager
  • Shoba W. Hariharan, Audit & Evaluation Officer
  • Jodi Shea, Project Officer
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