Compliance Review

Overview

Prevention and Loss Management Services Branch (PLMS) staff conduct compliance reviews on selected cases based on risk assessments, data matching or allegations from the general public or ministry staff to confirm recipients received assistance for which they were eligible.

Compliance reviews minimize loss to the ministry by focusing on those areas of the BC Employment and Assistance Program that are subject to abuse.  Staff completing compliance reviews consider the following:  

  • Unreported income and or assets reported by data matches with other federal and provincial government agencies
  • Specific risk factors causing cases to be identified for review by the File Review and Distribution System
  • Allegations of overpayment or fraud

Ministry staff conduct compliance reviews under the authority the Employment and Assistance Act and Regulation and the Employment and Assistance for Persons with Disabilities Act and Regulation.

Policy

Effective:  July 5, 2007

Compliance reviews are administrative processes to determine the accuracy of information used to determine current and past eligibility. It includes examining and analyzing information on a recipient’s case, gathering additional information, recording outcomes, and if necessary, adjusting the amount of assistance and/or identifying, calculating, providing notification of overpayment and recording debt. 

Reviews are conducted in accordance with the principles of administrative fairness to ensure the recipient is made aware of eligibility issues and has an opportunity to respond to identified issues.  The ministry may determine whether the recipient is required to complete the review “in person” in the ministry office or over the telephone.

Recipients are required to provide shelter, financial, identification, and any other required documents to verify information and confirm their eligibility for assistance.

Effective:  November 24, 2014

Investigative Officers conduct compliance reviews as often as required based on an assessment of the risk that the recipient is receiving or has received assistance for which they are not eligible.  Cases identified by Allegation Fraud Incidents, the File Review and Distribution System (FRD), Canada Revenue Agency or Provincial Student Loan Data Matches are listed on the PLMS System.  Investigative Officers select cases on which to conduct compliance reviews from this list based on the risk of loss to the ministry.

Effective: July 5, 2007

At the review, documents and information provided by the recipient are to be verified for accuracy. This may require further documentation from the recipient or through third party checks. These checks may include but are not limited to:
 

  • BC Assessment
  • Personal Property
  • Consumer Credit Report (Equifax)
  • Insurance Corporation of BC (ICBC)
  • Canada Revenue Agency (CRA)

Note: Some recipients may have not filed an income tax return for previous years.  Filing an income tax return is not a condition of eligibility.  However, a recipient must file an income tax return and submit an application for the Canada Child Benefit (CCB) to receive the Family Bonus.

[For detailed information on Verification, see Related Links – Information and Verification.]

Procedures

Effective:  November 24, 2014

Investigative Officers (IOs) conduct compliance reviews based on analysis of the risk that a recipient is being or has been overpaid assistance. When conducting a compliance review, the IO is required to complete all the following steps:
 

  • Review case: notes, scanned documents, and payment history as applicable
  • Confirm valid consents are present on the case and, if applicable, co-applicant consent
  • Verify all required ID is scanned and profiled to the case/contact, as applicable
  • Confirm shelter expenses with applicable documents
  • Review income and asset information and confirm documentation is scanned and profiled
  • Complete all mandatory third party checks
  • Record the outcome of the review on the Prevention and Loss Management Services (PLMS) System
  • Scan and profile completed Compliance Review package

Every Compliance Review is unique. Depending on the different contributing factors that identify a case for review, an IO may be required to perform additional steps to conduct and complete the Compliance Review. These steps include:
 

  • Contacting recipients to resolve issues or confirm new information by sending a request for information letter (HR3196 or HR3197) [see Forms and Letters]
  • Making adjustments to assistance, for example increasing or decreasing the amount of assistance or stopping cheque production
  • Making appropriate referrals to other sources of income (i.e. CPP, OAS, EI)
  • Consulting with their supervisor if considering a referral to a Ministry Investigator (MI)

When an overpayment is identified, or an adjustment to assistance is made, additional steps are required, unless the case is to be referred to an MI. If, after consultation with the Supervisor, the case is referred to an MI, the IO makes the referral and completes the Compliance Review. If not referring to an MI, the IO is required to:
 

  • Communicate decisions to recipients directly
  • Ensure the recipient understands their /responsibilities including the responsibility to declare changes that may affect eligibility
  • Ensure the recipient understands the right to reconsideration and appeal, and provide a Reconsideration and Appeals brochure [see related links – Reconsideration and Appeal]
  • If reconsideration is requested by the recipient, the IO is required to complete the Request for Reconsideration for the recipient [see related links – Reconsideration and Appeal]
  • Calculate and record an overpayment on the Overpayment Calculator (OPC) in accordance with policy and procedures

During the course of a review Investigative Officers may complete an eligibility review using the HR0080R. For example, this may be necessary if recipients provide new information regarding a spouse, dependents, assets or if a new consent is required.

In consultation with their supervisors, IOs may complete and record an allegation on an Allegation Fraud Incident if referral to a Ministry Investigator is appropriate. If an IO makes a referral for investigation, they must also record the referral on the PLMS system.
 

  • Investigative Officers (IOs) will communicate and consult with Employment and Assistance Workers (EAW) throughout the review, via the system.

Effective:  September 3, 2009

The Investigative Officer (IO) may request a meeting with the recipient to discuss an adjustment to assistance, an overpayment, to clarify information, or to obtain required documentation.
 

  1. Send meeting appointment request letter (HR3557 or HR3558) to the recipient to initiate a meeting. Send a second meeting request letter (HR3559 or HR3560) if the client fails to respond to the first letter or fails to attend the scheduled meeting [see Forms and Letters]. All recipients, especially those who are disabled, aged, or have barriers to communication, are encouraged to be accompanied by a friend, family member, or advocate, in order to ensure they fully understand the issue(s) to be discussed.
     
  2. At the meeting, confirm the identity of the individual(s) by:
  • reviewing the identification produced by the recipient(s);
  • reviewing the identification previously received; or
  • if no identification is available, noting a detailed physical description of the recipient(s) and obtaining personal information that may be verified.  Make note of this information on the case.
  1. Advise the recipient of the purpose of the meeting and that they may leave the meeting at any time.

Meeting/Appointment Request Correspondence is Returned

  1. If the appointment letter is returned to the ministry by the post office or courier and the person is still in receipt of assistance, it is necessary to verify their residential address to confirm their eligibility for ongoing assistance. Contact recipient and obtain applicable documents to verify their residence. 
  2. If the recipient’s case closes and the Meeting Request is returned marked 'moved' or 'unknown' and a new address cannot be located, place an eligibility alert on the case/contact. 

Recipient Does Not Attend the Meeting

If the first and second meeting request letters are not returned by the post office and recipients either do not respond to the letters or refuse to meet with staff to discuss their eligibility, the IO may place a hold on the recipient’s next assistance cheque and add a note on the case to explain that the recipient failed to attend a Compliance Review appointment to re-assess their eligibility. Send a notification of decision letter (HR3561 or HR3198) along with a Reconsideration and Appeals Brochure [see Forms and Letters]. 

[For information about third party checks used to verify information, see Related Links – Information and Verification; For information on meeting with clients regarding overpayments and recording overpayments, see Related Links – Recoveries]

Authorities and Responsibilities

 

Responsibilities

Effective:  November 24, 2014

Investigative Officer (IO) is responsible for:
 

  • conducting compliance reviews on selected cases generated by the File Review and Distribution System (FRD), data matching or allegations from the general public or referrals from ministry staff recorded on Allegation Fraud Incidents. 
  • adjusting ongoing assistance if appropriate
  • calculating and recording overpayments
  • ensuring the required documentation is scanned and profiled