Case Audits

7-4 Case Audits


PURPOSE



1. To provide cost control and accountability feedback in relation to the provision of Social Assistance benefits.



PRINCIPLE



2. Applicants and workers must be held accountable for the expenditure of public funds.



3. Case audits confirm the accuracy of information given by an applicant and entitlement to Social Assistance benefits and also to ensure workers apply only approved policies.



4. Case audits provide useful information for the development or refinement of policies and procedures, relevant staff training, improved case management and service delivery.



5. Information related to apparent attempts to defraud may be more appropriately gathered by an independent third party with special skills and knowledge in this area.



POLICY



6. The case auditor will conduct both random and requested case audits which shall include:

(a) Financial Case Audit - To verify income and expense statements; to confirm that eligibility was established in accordance with regulations and policy; to ensure the appropriate benefit was awarded.



(b) Administrative Case Audit - To check for required documentation; completion of appropriate forms; and content quality.



7. Case Audit Reports shall indicate the findings of the audit plus any related corrective recommendations. Comments regarding, but not limited to, the following may be made:

(a) Termination or adjustment of awards or benefits;

(b) The desirability of a referral for prosecution consideration;

(c) Observation in relation to worker error;

(d) The need for new or revised procedures;

(e) Improved case administration.



8. In situations where the Case Auditor has reasonable grounds for doing so, he/she may recommend the holding of an applicant’s cheque until the concern is resolved. "Reasonable grounds" may include but are not limited to:

(a) Situations in which Social Assistance abuse is evident;

(b) Situations in which contact with the applicant cannot be made, after reasonable efforts;

(c) Situations in which major discrepancies between actual and allowable expenses and income are indicated.

(d) Situations in which the applicant refuses to participate in the case audit process.



PROCEDURE



9. Routine case audit procedure is as follows:

(a) The Case Auditor shall contact the Social Assistance office (with or without advance notice) and request the files to be audited;



(b) Upon completion of the audit, the Case Auditor shall prepare his/her audit report. 124, retain one copy with copies of relevant supporting documentation and send the original to the designated authority.



(c) Appropriate Social Assistance staff shall further inquire or review and respond by completing the appropriate section on the form and returning it to the Case Auditor within 30 days of receipt of the Audit Report form. If a response cannot be made within the above time frame, the reason(s) for delay will be documented and forwarded to the Case Auditor before the expiration of the 30 day period.



(d) The Case Auditor shall log the returned audit forms and forward them, along with a copy of the related Case Status Sheet, to the Financial Services Manager, Department of Social Services and Seniors, with a copy to the appropriate Area Coordinator once per month.



(e) The Financial Services Manager shall enter any comments and return the forms to the Case Auditor, who in turn will log them again and forward the original to the appropriate office for inclusion in the client file.



10. In situations where the Case Auditor recommends that an applicant’s cheque be held, immediately he/she shall inform the region, giving the reason for that request. Notification may be provided in writing or verbally.



11. More generalized audit observations related to regulation, policy, procedure, case administration and service delivery shall be reported by the Case Auditor to the Financial Services Manager who in turn shall forward the report to the Director of Social Programs and the Deputy Minister of Social Programs and Seniors.