Referral for PLMS Review or Investigation

Effective: August 15, 2008

In accordance with Section 10 of the Employment and Assistance Act and Employment and Assistance for Persons with Disabilities Act, Quality and Compliance Specialists (QCS) conduct compliance reviews targeted at detecting alternative sources of income or other undeclared circumstances and avoiding potential error and fraud. These compliance reviews may be generated based on risk assessments, data matching, allegations from the general public, or referrals from ministry staff [for more information, see Related Links – Compliance Reviews].

Data matching is conducted under the authority of Section 10 of the Employment and Assistance Act and the Employment and Assistance for Persons with Disabilities Act and in accordance with the terms and conditions of information-sharing agreements. With client consent, information provided by clients is verified with the Canada Revenue Agency, Ministry of Advanced Education, StudentAid BC Program, and Service Canada (Canada Pension Plan).

QCSs may help ministry clients explore eligibility for other benefit programs such as Canada Pension Plan or Old Age Security. This may include assisting clients with their benefit applications and ensuring that any relevant assignment forms are completed to preclude duplicate assistance or benefits. QCSs may request that Employment and Assistance Workers (EAWs) assist with or follow up on these applications and assignments.

QCSs may identify, calculate, and record overpayments in accordance with Section 28 of the Employment and Assistance Act and section 19 of the Employment and Assistance for Persons with Disabilities Act. QCSs follow policy and procedures outlined in the Recoveries section and apply the principles of administrative fairness throughout the debt establishment process and overpayment recovery. [For more information, see Related Links – Recoveries.]

Effective: August 1, 2015

Allegations of overpayment of assistance or fraud may be received from external sources, such as calls from the public, or internally through Employment and Assistance Workers (EAWs) or other ministry staff.

Ministry staff must refer all matters of suspected or alleged fraud to the Prevention and Loss Management Services Branch (PLMS). This includes situations where the client’s assistance case is closed.

Allegations of overpayments and fraud are reviewed, assessed, and assigned to Quality and Compliance Specialists (QCS) for review or to Ministry Investigators for criminal investigation. When conducting compliance reviews generated by allegations, QCSs focus on establishing facts that prove or disprove compliance with the legislation governing the British Columbia Employment and Assistance programs.

Sanctions may arise from non-reporting of income, assets or other circumstances resulting in an overpayment, or a deduction from assistance may arise from conviction under the Employment and Assistance Act or Employment and Assistance for Persons with Disabilities Act or the Criminal Code of Canada.[For more information, see Related Links – Sanctions.]

EAWs calculate and record overpayments that do not exceed three months’ assistance if there are no current open Investigation Incidents, unless the case meets the criteria for a PLMS referral [see Procedures – Fraud Allegations and Referrals].

Effective: January 19, 2015

Allegations of fraud are recorded by staff on an Allegation Fraud Incident or by the public on the online fraud reporting site.

Allegations are submitted using the Allegation Fraud Incident when staff identify potential fraud during a review or following a report from the public. The public can report allegations by phone, in writing, in person, or by completing an online form that creates a restricted Allegation Fraud Incident. This form can be accessed through the ministry’s public website. [See Additional Resources – Fraud Allegation Reporting Online.]  

EAWs ensure that a client’s current eligibility has been assessed and verified by appropriate documentation when making a fraud allegation referral to PLMS.

EAWs calculate overpayments using the Overpayment Calculator tool (OPC) when ministry error overpayments are identified or when client-initiated overpayments do not exceed three assistance months and there are no open PLMS Review service requests on the case or Investigation Fraud Incidents on the contact.

When recording an allegation, staff should provide as much detail as possible. If the client has admitted liability and is willing to repay the overpayment, this should be indicated in the allegation details.

PLMS Coordinators and Assessors use the Assessment screen to record their assessment of the initial allegation. The Coordinators/Assessors either close the allegation or assign it for further review by sending it to the PLMS system for a Compliance Review, or sending to the Criminal Investigations Unit for an investigation.

Cases requiring PLMS QCS compliance reviews will be entered electronically into the PLMS System. If the case is already listed on the PLMS System, the allegation information is added to the existing record as a new source.

In cases where fraud is suspected, EAWs may consult with PLMS staff for advice and direction prior to or subsequent to submitting an allegation. Once a review or investigation by PLMS is in progress, EAWs must not respond to client queries about the review or investigation and should refer the client to the local PLMS office.

Note: Even if the client does not require further assistance and the case is closed, a referral is still necessary if there appears to be a client-initiated overpayment.

Effective: November 24, 2014

All fraud allegation referrals are submitted using the Allegation Fraud Incident. The following is a list of the various types of fraud and the information that is required by Prevention and Loss Management Services Branch (PLMS) to start a review or an investigation.

Duplicate Assistance

Allegations of duplicate assistance are investigated by Ministry Investigators (MIs). If it appears that a client is collecting assistance on more than one case, staff must:
 

• Contact PLMS immediately and speak to a MI. The MI will assist in determining which cases should be stopped and how, when, and where to deal with the client.
• Make note of all relevant documentation.
• Not confront the client.

Identification

Allegations involving false identification are investigated by MIs. If it appears that the client is not who they claim to be, staff contact PLMS immediately and speak to a MI. The MI will decide if immediate action is required by PLMS and will assist in determining what steps to take.

If sufficient identification is unavailable at the time of application, staff should obtain as much personal information as possible from the applicant, including a detailed physical description. Ministry staff may be required to identify the client for court purposes at a later date.

If a fraud referral is required, staff must note relevant documentation.

Undeclared Income

Employment Income

If the allegation concerns undeclared employment income, staff record as much information as possible, including, if known:
 

• employer name (corporate/business/personal), address, and telephone number
• type of work, approximate wage, and duration of employment

Staff will contact the client to advise that information has been received that they may be working, request pay stubs, if appropriate, and follow up as required for current and past eligibility. Staff are to make notes on the client’s response to the allegation.

Note: The use of the Confirmation of Earnings (HR2181A or B) forms is for PLMS only.

Self-Employed Income

If the client has the Persons with Disabilities (PWD) or Persons with Persistent Multiple Barriers (PPMB) designation, staff reviews the case to determine if the client is registered in the Self-Employment Program. If the client is not registered in the Self-Employment Program, or if the potential overpayment is greater than three months’ assistance, staff are to include as much information as possible regarding the client’s self-employment or small business income, such as how long the person has been operating the business, type of business, and business location.

[For more information, see Related Links – Self Employment Program (SEP) for PPMB and PWD.]

Undeclared Assets

Undeclared Property

If it is alleged that a client owns real estate, staff are to include as much information as is known, such as property value and the address, city, or municipality where the property is located.

Undeclared Financial Assets

Where the client allegedly has undeclared financial assets, such as a Registered Retirement Savings Plan, Guaranteed Investment Certificate, term deposit, annuity, or trust account, the following information should be recorded, if known:
 

• name and location of the financial institution holding the asset
• account number and value of asset

Undeclared Vehicles or Other Personal Property

For allegations regarding undeclared vehicles or other personal property, such as a mobile home or boat, both of the following should be requested and recorded:
 

• year, make, and model
• if available, a copy of the registration, sales document, or lease agreement

Beneficiary of Will or Trust

Where the client is allegedly a beneficiary under a will or trust, any documents should be recorded. The full name of the deceased and date and location of death should also be provided, if known.

False Address

When a client is believed to be living somewhere other than the address they claim to reside at, the client’s entire eligibility should be reviewed. Staff are to make notes regarding attempts to confirm current eligibility in respect to the residence, including information from the landlord, and record any shelter documentation.

Dependent Child Status

When information suggests that a reported dependant is not living with the client, staff should record the following information, if known:
 

• who has custody of the children
• whether there is a court order
• whether the EAW has seen the children and whether there is identification on the case
• whether there are any independent witnesses
• documentation, including court orders or agreements relating to custody

[For information about dependency relationships, see Related Links -  Family Composition.]

Spousal Status

An allegation may relate to an undeclared spouse or to a spouse who is a dependant on the client’s case, but is not living with the client.

Staff apply the Employment and Assistance Act and Employment and Assistance for Persons with Disabilities Act definitions of ‘dependant’ and ‘spouse’ to determine whether the client’s current and past eligibility for assistance are assessed correctly. [For more information see Related Links – Family Composition.]

For allegations related to spousal status, staff  records the following information regarding the alleged spouse, if known:
 

• full name
• date of birth
• Case number (if the alleged spouse is also a recipient of assistance)
• marital status
• employment status
• length of the alleged dependent relationship

Lost or Stolen Cheques

All lost or stolen cheque referrals come directly from the Financial and Administrative Services Branch (FASB) to PLMS. A referral is not required from the Employment and Assistance Office. [For more information, see Related Links – Replacement of Lost or Stolen Cheques.]

Criminal Investigations

Supervisors of Criminal Investigations (SCIs) assign allegations of criminal activity relating to the BC Employment and Assistance Program to Ministry Investigators (MIs).

MIs are responsible for investigating allegations of serious criminal activity and making referrals to Crown Counsel for prosecution if appropriate. MIs perform a complete range of investigative functions: gathering evidence, interviewing clients and witnesses, preparing and executing search warrants, preparing reports to Crown Counsel, testifying in court, registering court restitution orders, and preparing affidavits.

For investigations opened prior to April 2, 2012, MIs recorded information using the Investigation (IN) system on MIS. For investigations opened on or after April 2, 2012, investigations are recorded as Investigation Incidents in ICM.

Effective: August 1, 2015

Quality and Compliance Specialists (QCS) record the results of their compliance reviews on the PLMS System. These results will be listed on the ICM Case (More Info View Tab; Compliance Review Sub-View Tab).

Ministry Investigators (MIs) record the outcomes of their investigation using the Investigation Registration and Conclusion Report (HR0204A) form, which is scanned and profiled to the Investigation Incident, and the original filed on the physical investigation file.

If the compliance review or investigation results in an overpayment, the QCS or MI adds the debt to the case, and applies the sanction or consequence to the contact(s) if applicable.

[For more information on sanctions, see Related Links – Sanctions. For more information on debt recovery, see Related Links – Recoveries.]

Effective: August 1, 2015

Referral for PLMS Review or Investigation
Position	Authority
PLMS Supervisor of Criminal Investigations (SCI)	Assigns cases for criminal investigation In consultation with the Policy and Program Implementation Manager, the SCI can temporarily lift  conviction sanctions imposed by Ministry Investigators.
Fraud Coordinator (FOC) and/or Allegation Assessment Coordinator (AAC)	Conducts initial assessment of fraud allegations and forwards cases for review or investigation.
PLMS Supervisor	Oversees compliance reviews conducted by Quality and Compliance Specialists Approves waiving of sanctions Approves overpayment charts Approves residency verifications
Field Manager or Director of Service Delivery or PLMS Operations Manager or Operations Director	Recommends write-off requests on open cases
Financial and Administrative Services Branch	Collects outstanding debts through collections and court action for debts owed by individuals who are no longer in receipt of assistance. Authorizes write-off requests on open or closed cases