INTENT

To ensure matters of suspected or alleged crimes of deceit perpetrated against Human Services programs and services are investigated.

POLICY

For the purposes of the Learner Income Support (IS) program, regional Investigation Units’ mandate is as follows: 

• Investigate the incidence of suspected or alleged crimes of deceit perpetrated against Human Services programs and services.
• Investigate and recommend or complete actions including the recovery of funds and prosecutions, where applicable.
• Support the overall goals and principles of the IS Program.

The applicable legislative authorities that apply to Investigation Units for the purposes of the Learner Income Support program include:

• Criminal Code of Canada 
• Income and Employment Supports Act
• Canadian Charter of Rights and Freedoms
• Freedom of Information and Protection of Privacy Act
• Alberta Peace Officer Act
• Canada Evidence Act
• Adult Interdependent Relationships Act

If a file is referred to an Investigation Unit, at no time does the Learner Income Support Office (LISO) Program Compliance Officer (PCO) discuss an option of recovery activity with the Learner without speaking to the Investigator.

When and if it is determined by an Investigation Unit that the Learner should be criminally prosecuted, the Investigator will keep the PCO informed of the status of the file while going through the court process. Once the case has been concluded the Investigator completes a concluding report on the EMP 1391 Investigation Report and returns the Human Services file to LISO.

Definitions

In general, fraud and related crimes of deceit are proven when a person is found guilty of an offence under the Criminal Code of Canada because they have defrauded or attempted to defraud the public of property, money or other valuable security through deceit, falsehood or other fraudulent means. A person can be found guilty of an offence only if all of the elements of the offence have been established beyond a reasonable doubt.

Some examples of when a person may be found guilty of fraud and related crimes of deceit under the Criminal Code of Canada are when they have been proven to have: 

• Given false material information about income, assets or needs. 
• Withheld information about income, assets, or needs. 
• Used an alias to obtain duplicate assistance or to conceal income or assets. 
• Given false information to obtain benefits to which he or she is not entitled.
• Stolen an item or misappropriated benefits.

Program Compliance Officer Responsibilities

PCOs are responsible for identifying and deterring potential misuse of program funds or benefits. Misuse of program funds or benefits is not necessarily criminal in nature. The incidence of unintentional misuse of program funds and benefits can be reduced when Authorized Officials educate applicants/recipients about the requirement to disclose their true circumstances and follow Learner Income Support policies and procedures.

PROCEDURES

Action on Active Learners
When the complaint is received by an Investigation Unit, the unit will: 

• Record the information on EMP 1317 Complaint Record, or 
• Record the information on the Complaint Form in the Fraud Investigation Tracking System, and 
• Forward the information to the PCO for review and validation.

When a complaint is received from a member of the public at an Alberta Works Centre or the Student Funding Contact Centre, the caller is referred to the PCO in LISO.

The PCO asks the caller to provide as much specific detail as possible. For example, if the caller is reporting that a client is cohabiting, the PCO attempts to find out: 

• The name and address of the spouse or partner. 
• The length of time the client is alleged to have been cohabiting

To follow-up, the PCO will: 

• Review the client’s file to determine if the information has been previously disclosed by the client (e.g., LISO may know the client is cohabiting). 
• Attempt to verify the information presented. This may involve contacting an alleged employer, financial institution, or landlord. 
• If there is a discrepancy between the information that may have an impact of the client’s initial or continued eligibility contact the client to give them the opportunity to clarify the information.
• Record all findings in Mobius Notes.

If the client: 

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 potential for program abuse, documents the outcome in Mobius Notes and if applicable:
     
   • Enters and applies the new evidence into Mobius
   • Reassesses Learner Income Support and Training Benefit eligibility
   • Send a Post-Verification Decision letter to the client
      
3. Admits program abuse or the PCO determines there is sufficient substantiated information to refer the matter to an Investigation Unit, the PCO:Informs the client that an investigation referral will be made, and
    
   
   • Completes EMP 0037 Request for Investigation, and
   • Documents all information in Mobius Notes
      
4. Provides an unsatisfactory explanation of the new information and the PCO  strongly suspects program abuse without having substantiating information, the PCO:
    
   
   • Consults with the LISO Supervisor who may in turn consult with the LISO manager and/or appropriate regional Investigation Unit to determine if the file should be referred for investigation.
   • Acts on suggestions made by the Investigation Unit which may include contacting other resources, verifying further information, making a referral for an investigation or taking no action at this time.
   • If determined a suitable referral, complete EMP 0037 Request for Investigation. 
   • Documents all information in Mobius Notes.

Action on Inactive Learners
When the complaint is received by an Investigation Unit, the unit will: 

• Record the information on EMP 1317 Complaint Record, or
• Record the information on the Complaint Form in the Fraud Investigation Tracking System, and
• Forward the information to the PCO for review and validation.

When a complaint is received from a member of the public at an Alberta Works Centre or the Student Funding Contact Centre, the caller is referred to the PCO in LISO.

The PCO asks the caller to provide as much specific detail as possible. For example, if the caller is reporting that a client is cohabiting, the PCO attempts to find out: 

• The name and address of the spouse or partner. 
• The length of time the client is alleged to have been cohabiting

To follow-up, the PCO will: 

• Review the client’s file to determine if the questioned matter occurred during the period the client was in receipt of benefits and if the information had previously been disclosed by the client  (e.g., the client has been cohabiting), and 
• If required, attempt to verify the information presented. This may involve contacting an alleged employer, financial institution, or landlord. 
• Record all findings in Mobius Notes. 
• If program abuse is suspected, complete EMP 0037 Request for Investigation and forward to the appropriate Investigation Unit.
  
  Note
  There are six regional Investigation Units across the province. Matters of suspected or alleged crimes of deceit should be forwarded to the Unit closest to the Learner’s home address. If the Learner has left the province, matters are to be sent to the Edmonton Region Investigations and Review Unit

Completion of EMP 0037 Request for Investigation
When completing the EMP 0037 Request for Investigation, the PCO must:

• Outline the circumstances including the original complaint, and 
• Indicate the steps taken to verify the information, and 
• Note the interviews/conversations with the client, 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 and any supporting documentation to the appropriate Investigation Unit.

Investigation Process
The EMP 0037 Request for Investigation is initially reviewed by an Investigation Supervisor or Manager. The request may be accepted for further evaluation if the following criteria is met:

• The investigation referral must be within the mandate of Investigation, and
• Involve one of the Human Services programs (i.e., Learner Income Support), and
• Must allege program abuse, and
• Human Services must be the victim.

Referrals that do not meet the above criteria for acceptance are rejected and:

• No investigation is conducted and the office copy of the EMP 0037 Request for Investigation is returned to the PCO within LISO with any follow-up recommendations, including the completion of an overpayment.
• If at a later date the recommended follow-up has been completed and there is still a need for investigation, the PCO or LISO may re-submit the EMP 0037 Request for Investigation.

An investigation may be commenced if there is reason to believe a person has or attempted to:

• Give false information about personal and family/household information, income, assets, needs or living circumstances,
• Withhold material information about personal and family/household information, income, assets, needs or living circumstances,
• Used false identification to obtain assistance or to conceal income or assets,
• Illegally obtained funds from Human Services.

Once an Investigation Unit has determined a referral is deemed appropriate for investigation, the EMP 0001 Investigations Point Rating Prioritization Tool is used to determine if the referral will continue into a full investigation. If a referral meets the criteria guidelines contained in the prioritization tool, the Investigator will begin an investigation into the complaint. If a referral does not meet the criteria guidelines, the Investigator follows internal procedures regarding referrals that do not continue into an investigation.

Case Dispositions
The Investigator reviews all information collected regarding the investigation to determine the case disposition.

Case dispositions fall into one of the following three categories: 

1. Unfounded Allegation 
   • The allegation(s) is not based on fact and a criminal offence is not suspected.
   • The Investigator completes a concluding report on the EMP 1391 Investigation Report and returns the original file and a copy of all pertinent information to the Human Services office.
     
2. Unsubstantiated Allegation
   • The allegation is unsubstantiated as it can not be proven or disproven.
   • The Investigator completes a concluding report on the EMP 1391 Investigation Report and returns the original file and a copy of all pertinent information to the Human Services office.
     
3. Substantiated Allegation

1. Administrative Action
   
   • The allegations are confirmed; however, prosecution is not pursued due to administrative error, insufficient evidence or it is not practical to prosecute.
   • The administrative action could include recovery or other administrative control recommendations specific to a file.
     
2. Criminal Prosecution
   
   • Admissible evidence establishes all of the essential elements of the alleged offence and circumstances warrant prosecution.

When it has been determined that recovery action (overpayment) is to be taken the Investigator:

• Forwards the overpayment information to the PCO and completes a concluding report on the EMP 1391 Investigation Report and returns the Human Services file.

Note
The Overpayments and Debts policy including advising the client of the right to appeal must be followed.

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