File Audit Review Presentation

Presenter: Melissa Sayers

What is a File Audit Review?

A File Audit Review is a standardized method of reviewing the files of all Ontario Works delivery sites across the province. It is to ensure that files and sites are in accordance to the OW act, guidelines and policies.

File Updates: Caseworkers will do an annual file update

with each client to ensure that everything is documented properly on file.

Forms need to be re-signed and updated such as, Form 1’s, Rights and Responsibilities, Consent to Disclose, Participation Agreements, Form 2212’s

All mandatory forms need to be signed, commissioned and dated in the proper places.

In order to determine eligibility, the client is required to provide information regarding new or changed circumstances which may effect eligibility or the amount of income support received.

Some examples are: Income Earned

Income Statements

Pay Stubs

Rent receipts

Hydro, gas, oil, bills

Mortgage agreements

Child/Spousal support

Assets - such as cars, boats, snowmobiles, trailers., etc.

Some verification documentation that need to be on file are :

Birth Certificate

Health Card Number (verified only)

Social Insurance Number (verified only)

Passport

Marriage Certificates

School Records

Indian Band Records

Drivers License

Some other proof of documentation that clients need to bring in are:

Proof of Debt such as credit cards, loans

OSAP

School Verifications such as report cards

Proof of Citizenship such as passport or letter of proof they are a Canadian Citizen

Ownership papers and Insurance

A change of address

Separation/Divorce papers

Bank Statements

Required documentation

Must be visually verified and noted on your technology system or

Photocopied and placed on master file for verification

Failure to provide such documentation may result in a decision of ineligibility or cancellation of assistance.

Monthly Reporting Requirements and Changes in Circumstances

Earnings from employment is to be reported monthly by all members of the benefit unit.

The file should contain pay stubs to show wages, vacation pay,

commissions, tips, etc.

Also Child Care costs and related receipts should also be kept on file.

Some examples of files that would be reviewed are:

Residency arrangements

Co-Residency

Living With Parent

Applicants Under 18

Trusteeship

Pay Directs

Temp Care Custody

Sponsored Immigrants

Some Participation examples are:

Employment Supports/Basic Education

LEAP

Literacy Screening

Addictions Services Initiatives

Employment Placements

Community Placements

Child Care Supports

Asset Examples are:

Summary of Assets

Asset Limits

Property

Motor Vehicles

Settlement Agreements

Pension Plans,

RRSP’s

Life Insurance

Prepaid Funerals

Funds Held in Trust

What happens if a client fails to provide the information?

If the client does not provide the information that the OW office asks for, the client’s assistance could be cancelled/suspended or reduced until they do.

But if the client has made reasonable efforts to get the information or documents, their assistance should not be cancelled or reduced.

Third Party Checks Third Party Checks include requests from the

following:

Ministry of TransportationEquifax (credit check) Family Responsibility Office (FRO)Canada Revenue Agency (CRA) Employment Insurance (EI)

Some Compliance Tools used are:

The tools used by MCSS to do file audits and to determine continual eligibility of social assistance in the following categories:

Initial Eligibility

Financial Assistance

Intake Process

Participation Requirements

Mandatory Benefits

Termination/Cancel of Benefits

Lets take a look at some key points that each of these tools contain

Initial Eligibility

Was the application completed and signed by all members of the benefit unit?

Was all mandatory forms commissioned?

Are all required documents on file?

Are all other documentation been visually verified and noted on file?

Initial Eligibility Is there a Verification Checklist

completed and on file?

Are there proof of identification of everyone in the benefit unit?

Are case notes noted to indicate decisions of assistance?

Financial AssistanceHas proper accommodation costs

been verified?

Were earnings/income declared for all members of the benefit unit?

Are there any child/spousal supports payments?

Assets

Northern Allowance

Intake Process

How was the initial contact noted?

Has the date of initial contact been dated?

Was the client notified of all the required documentation they should bring for their intake appointment?

How long from the initial point of contact and the intake date been?

Participation Requirements

Was the participant deferred at any time?

Is there documentation on file do support this decision?

Was the Participation Agreement completed and monitored?

Are PA’s updated every 3 months?

Are there PA’s for all adults and dependent adults in the benefit unit?

Participation continuedWere there outstanding activities

pertaining to employment assistance?

Were skills listed consistent with client’s skill experience, circumstances?

Were timelines consistent with policy directives?

Was Employment related expenses issued?

Participation continuedWas the client required to do Independent Job

Search?

Is the client enrolled in Basic Education or skills training?

Is there a Literacy Screen Test on file?

Is the client Self Employed?

Is the client participating in Community or Employment Placements?

LEAP

Mandatory Benefits

Were there any Mandatory Benefits issued for any of the following reasons and are all proper documentation on file?

Diabetic SuppliesMedical TransportationVision CareDental CoverageDrug CardsCommunity Start UpSpecial DietPregnancy Allowance

Termination or Cancel of Benefits

Was appropriate reason stated on file?

Was it voluntary?

Is there adequate documentation on file to support termination/cancellation of benefits?

Is there a copy of a closing letter stating why the file is being closed?

The next few slides show findings from MCSS

The areas that need improvement is Non-Compliance. Here is an example and could have been a cost of recovery on just two questions.

Was the application signed by all members of the benefit unit?

Does the amount for financial assistance issued for shelter reflect verified actual costs up to the maximum shelter amount?

From these two basic questions the following is the amount that could have been potential recovery from your community.

What is the most common file errors made in a File Audit

Review? Here are a few key factors noted from

former PRO’s : the most common mistakes are:

Lack of documentation and incomplete documents like Form 1

Not signed or commissioned.  Sections left unanswered.  Non verified shelter costs. No receipts  No Case notes that explain decisions made.

Potential Recovery

Number of Sites Reviewed

Potential Recovery

2007 29 725,790.50

2008 31 676,866.81

2009 11 200,238.91

Was an application completed and signed by all applicable members of the benefit unit (i.e. applicant, spouse, dependent adult ) on file?Answer No

Does the amount for financial assistance issued for shelter reflect verified actual costs up to the maximum shelter amount? Answer No

Total of two questions

Total Percentage of Potential Recovery

2007 185,654.32 $307,351.43 $493,005.75 67.9%

2008 $191,644.92 $394,843.65 $586,488.57 86.6%

2009 $83,304.71 $100,664.82 $183,969.53 91.8%

Scenario #1

Recipient notifies their Caseworker that his/her rent has increased and is asked to provide verification of the new rental amount. Recipient is already receiving the maximum shelter allowed under Ontario Works and rent was previously visually verified and noted on file.

Is the information and/or documentation requested essential for the determination of eligibility or the accuracy of the entitlement?

No. In this example, the recipient is already receiving the maximum shelter allowed under Ontario Works and therefore the shelter allowance would not be increased. The information is not essential for determining eligibility or the accuracy of the entitlement.

Scenario #2 The Caseworker requests verification of school records for a 10-year old dependent child. The information is not provided.

Is the information and/or documentation requested essential for the determination of eligibility or the accuracy of the entitlement?

No. Under the Education Act, it is the responsibility of school boards to monitor school attendance and satisfactory progress for children under the age of 18 and therefore, school records should not be requested.

All that needs to be documented on file are report cards.

Provide an example of when you would have to have attendance records on file?

Scenario #3A recipient reports that his wife has just given birth to their third child. A review of the file indicates that no previous information was provided that the spouse was pregnant. The recipient is asked to provide birth verification for the additional dependent. The information is not provided.

Yes, The information requested is essential for the determination of the accuracy of the family’s entitlement. However, the information is not necessary to determine the eligibility of the rest of the benefit unit.

How come? What would be change on the entitlement?

Continued… The client advises the worker that they have

applied to the Registrar General to obtain birth registration; however, they have been informed that the waiting period is three months. The client provides the hospital bracelet for the child and agrees to provide the notice of birth registration once it has been received.

Is this correct? Do you find this situation acceptable?

Scenario #4

Belinda is a 59 year old woman who is on assistance. During the file update and Third Party Check, it was noticed that she owns property in the next province that she has not told you about.

She states the property is runned down and nobody lives there so she didn’t think she had to claim it. It is winter and you notice that she has a hard time walking and needs a walker to assist her.

What would you do in this situation?

Scenario #5Sherry is a mother 5 children, but only has 3 in her care.

Her older two children live with her mother and, her mother receives Temporary Care for them. Sherry has been on and off assistance for the last 3 years. She constantly moves from the city to the reserve because of domestic violence.

Sherry said on her application she receives no child support from either of the 2 fathers of her children. After doing a file update and a Third Party Check, you find out that she has been receiving money from the father of the first 2 children all along. She was getting $200 a month, and was suppose to give the money to her mother but she hasn’t. The mother did not want to get her in trouble so she did no indicate that she knew she was getting the child support.

Would you put her in an overpayment or is this a fraud case and needs further investigation? What would you do?

Group WorkEach table will have their own file to work with.

Each file with have its own scenario. You will go through the file to make sure everything is in order in accordance to the OW act, Policies and Directives.

If anything is missing or you feel should be in the file, please make your file as you would in your First Nation.

Feel free to design your own documentation as it pertains to the file. Some may need, identification, rent receipts, PA updates, etc.

Afterwards you will pass your file to another group, and the other group will use the audit tool to your file to see if it is up to standards with legislation.