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Learner Policy & Procedures

Published Date: April 01, 2015
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Appeals and Reviews

Investigation

INTENT

To ensure matters of suspected or alleged program abuse against Human 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,
    • Alberta Works Centre, or
    • the Learner Income Support Office (LISO).

Request for Investigation

When a complaint is received, the Program Compliance Officer (PCO):

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

    Note
    Any complaints received by an Investigation Unit will be forwarded to LISO on an EMP 1317 Complaint Record form.

If the learner:

  1. provides a satisfactory explanation, the PCO documents the outcome in Mobius Notes and takes no further action.
  2. confirms the information and the PCO determines there is no program abuse but determines program misuse or misunderstanding, the PCO documents the outcome in Mobius Notes, and if applicable:
    • enters the appropriate change of circumstance;
      • if the change affects benefit calculation and an overpayment has occurred, Mobius will create a liability case as outlined in Recovery of Debts and/or
    • closes the file if the client no longer qualifies for benefits.
  3. admits to program abuse, or the PCO determines there is sufficient substantiated information to request an investigation, the PCO:
  4. provides an unsatisfactory explanation and the PCO strongly suspects program abuse without having substantiating information, the PCO:
    • completes an EMP 0037 Request for Investigation if the matter is determined suitable for investigation, and
    • documents all information in Mobius Notes.

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

  • 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, 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 learner’s file, (i.e., closed, active), and
  • forwards the EMP 0037 Request for Investigation to the Investigation Unit by email.
    Calgary: HS.CalFraudReferra@gov.ab.ca, all other areas: HS.IU@gov.ab.ca.

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

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 Human Services program (i.e. Income Support program, Assured Income for the Severely Handicapped), and
  • The matter alleges program abuse, and
  • Human 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 referring PCO to discuss details and notify of any follow-up recommendations to resolve outstanding issues.
  • Summary comments are entered into Mobius Notes by the worker.
  • If, at a later date, additional or new information is identified by the PCO and there is still a need for investigation, the PCO may re-submit the EMP 0037 Request for Investigation.

Investigation Report

The HSIU provides the referring PCO 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 LBC:

  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 HSIU results in a criminal charge, the referring PCO will be notified by the HSIU supervisor with recommendations for ongoing case management.
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