INTENT

To ensure matters of suspected or alleged program abuse against Seniors, Community and Social Services programs and services are investigated.

POLICY

Income Support staff are responsible for identifying and deterring potential misuse or abuse of program funds or benefits. Misuse of program funds or benefits may not be criminal in nature. The incidence of unintentional misuse of program funds and benefits can be reduced when staff educate applicants/recipients about the requirement to disclose their circumstances and follow Income Support policy and procedures.

A complaint regarding suspected or alleged crimes of deceit perpetrated against the Income Support  program can be identified by:

• a worker as the result of knowledge or concerns about the file,  
• a member of the public to an:
  • Investigation Unit, or
  • Alberta Works Centre  

 

Request for Investigation

When a complaint is received or suspected, the worker: 

• reviews the client’s file to determine whether the information regarding the complaint is already known,  
• checks Compass or CCD to determine if there is an active investigation.  If an active investigation exists, consults with the Investigator assigned to the file, 
• attempts to verify the allegations identified. This may involve contacting an alleged employer, financial institution, or landlord,  
• contacts the client to give them the opportunity to clarify the information, and 
• records all information in Compass Comments.
  
  

If the client:

1. provides a satisfactory explanation, the worker documents the outcome in Compass Comments and takes no further action.
2. confirms the information and the worker determines there is no program abuse but determines program misuse or misunderstanding, the worker documents the outcome in Compass Comments, and if applicable:
   • adjusts the benefit level accordingly, and/or 
   • applies the relevant overpayment policy and procedures, and/or
   • closes the file if the client no longer qualifies for benefits.
3. admits to program abuse, or the worker determines there is sufficient substantiated information to request an investigation, the worker:
   • informs the client that an investigation will be requested, and 
   • completes the EMP 0037 Request for Investigation, and
   • documents all information in Compass Comments.
4. provides an unsatisfactory explanation and the worker strongly suspects program abuse without having substantiating information, the worker:
   • consults with the Supervisor who may in turn consult with the appropriate Investigation Unit to determine if the file should be referred for investigation, and
   • completes an EMP 0037 Request for Investigation if the matter is determined suitable for investigation, and 
   • documents all information in Compass Comments.

 

When completing the EMP 0037 Request for Investigation, the worker:

• outlines the circumstances including the original complaint, and 
• indicates the steps taken to verify the information, and 
• notes the interviews/conversations with the client, and 
• notes the period of assistance of partial or total ineligibility with an approximate dollar amount involved, and
• references applicable policies and/or legislation used to assess eligibility, and
• includes details of the consultation with the Investigation Unit, when applicable, and 
• advises of the status of the client’s file, (i.e., closed, active, suspended at time of referral), and 
• forwards the EMP 0037 Request for Investigation to their supervisor.

Note
If a file is referred to an Investigation Unit, at no time does the worker discuss an option of recovery activity with the client without speaking to the investigator.

 

When reviewing the EMP 0037 Request for Investigation, the supervisor:

• ensures that the EMP 0037 Request for Investigation is suitable, and
• reviews the form to ensure all sections are sufficiently completed, and
• forwards the EMP 0037 Request for Investigation to the Investigation Unit by e-mail
  CSS.CSIU@gov.ab.ca.

 

The EMP 0037 Request for Investigation is reviewed and may be accepted for investigation if the following criteria are met:

• The matter is within the mandate of the Investigation Unit, and 
• The matter involves a Seniors, Community and Social Services program (i.e. Income Support, Assured Income for the Severely Handicapped), and 
• The matter alleges program abuse, and 
• Seniors, Community and Social Services is the victim.

 

Requests that do not meet the criteria for an investigation are rejected and:

• No investigation is initiated.
• The Investigation Unit supervisor will contact the referring supervisor to discuss details and notify of any follow-up recommendations to resolve outstanding issues.  
• Summary comments are entered into Compass Comments by the worker.
• If, at a later date, additional or new information is identified by the worker and  there is still a need for investigation, the Seniors, Community and Social Services office may re-submit the EMP 0037 Request for Investigation.

 

If the Investigation Unit requires the paper file, the worker requests Administrative Support staff create a new volume for the Alberta Works Centre.

Note
The new volume (not a duplicate) must follow Records Management standards.
Minimal photocopies of documents should be made since LISA has client and budget information for the previous three months and a 24-month payment history in CCD and Compass has Comments and Individual Plan information. Only documents that affect current benefits and those identified by the worker as necessary to administer the file should be photocopied. This may include:

• The EMP 3428 Income Support Application

Investigation Report

The Seniors, Community and Social Services Income Services Investigation Unit (ISIU) provides the referring supervisor an Investigation Report upon the conclusion of an investigation. The report summarizes the circumstances of the investigation, findings and may include suggestions for preventative actions. 

Based on the findings of the investigation, the worker:

1. adjusts the benefit level accordingly, and/or
2. enters an overpayment into the Recoveries System, and/or 
3. closes the file if the client no longer qualifies for benefits, and
4. documents all information in comments.
   
   Note
   In cases when a referral to the ISIU results in a criminal charge, the referring supervisor will be notified by the ISIU supervisor with recommendations for ongoing case management.