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2.0 About the Audit

2.1 Audit Scope and Objectives

The scope of this audit covered all relevant processes and expenditures from April 1, 2012 to March 31, 2013. The objectives of this audit were:

  • To assess compliance with applicable policies and processes;
  • To assess the adequacy of the management control framework; and
  • To determine timeliness of decisions.

The audit criteria are provided in Appendix A.

2.2 Methodology

This audit was conducted in conformance with the Internal Audit standards as outlined by the Institute for Internal Auditors, and is aligned with the Internal Audit Policy for the Government of Canada, as supported by the results of the Quality Assurance and Improvement Program. Table 2 outlines the audit methodologies used.

Table 2 - Audit Methodologies
Methodology Summary
Interviews Conducted with staff at Head Office, four Area Offices, and three Treatment Authorization Centres and staff at the health claims processing contractor to gain an understanding of and to assess the delivery of the Program including the authorization and payment processes. Information collected also supported the assessment of governance and internal controls for Related Health Services – POC 12.
Direct Observation Observed processes with Analysts in a Treatment Authorization Centre to obtain an understanding of Related Health Services – POC 12 processing using VAC’s Client Service Delivery Network (CSDN) and the FHCPS.
Documentation Review Verified that policies and procedures were current and aligned with regulations.
File Review Assessed compliance with applicable policies and procedures, as well as assessed the time taken to make decisions. Selected a random sample of 100 payment transactions from a population of 405,396 payment transactions between April 1, 2012, and March 31, 2013. The sample was selected based on highest risk, as determined by materiality of transactions and complexity of the approval and service delivery processes.
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