File Audit Review
Presentation
Presenter: Melissa Sayers
What is a File Audit Review?
A File Audit Review is a standardized
method of reviewing the files of all
Ontario Works delivery sites across
the province. It is to ensure that files
and sites are in accordance to the
OW act, guidelines and policies.
File Updates:
 Caseworkers will do an annual file update with
each client to ensure that everything is
documented properly on file.
 Forms need to be re-signed and updated such
as, Form 1’s, Rights and Responsibilities,
Consent to Disclose, Participation Agreements,
Form 2212’s
 All mandatory forms need to be signed,
commissioned and dated in the proper places.
In order to determine eligibility, the
client is required to provide
information regarding new or
changed circumstances which may
effect eligibility or the amount of
income support received.
Some examples are:
 Income Earned
 Income Statements
 Pay Stubs
 Rent receipts
 Hydro, gas, oil, bills
 Mortgage agreements
 Child/Spousal support
 Assets - such as cars,
boats, snowmobiles,
trailers., etc.
Some verification documentation that need to
be on file are :
 Birth Certificate
 Indian Band Records
 Health Card Number (verified  Drivers License
only)
 Social Insurance Number
(verified only)
 Passport
 Marriage Certificates
 School Records
Some other proof of documentation that
clients need to bring in are:
 Proof of Debt such as
credit cards, loans
 OSAP
 A change of address
 Separation/Divorce
papers
 School Verifications such  Bank Statements
as report cards
 Proof of Citizenship
such as passport or letter
of proof they are a
Canadian Citizen
Required documentation
 Must be visually verified and noted on your
technology system or
 Photocopied and placed on master file for
verification
 Failure to provide such documentation may
result in a decision of ineligibility or cancellation
of assistance.
Monthly Reporting Requirements
and Changes in Circumstances
 Earnings from employment  Also Child Care costs and
is to be reported monthly by
all members of the benefit
unit.
 The file should contain pay
stubs to show wages,
vacation pay, commissions,
tips, etc.
related receipts should also
be kept on file.
Some examples of files that
would be reviewed are:
 Residency arrangements
 Co-Residency
 Living With Parent
 Applicants Under 18
 Trusteeship
 Pay Directs
 Temp Care Custody
 Sponsored Immigrants
Some Participation examples are:
 Employment Supports/Basic Education
 LEAP
 Literacy Screening
 Addictions Services Initiatives
 Employment Placements
 Community Placements
 Child Care Supports
Asset Examples are:
 Summary of Assets
 Life Insurance
 Asset Limits
 Prepaid Funerals
 Property
 Funds Held in Trust
 Motor Vehicles
 Settlement Agreements
 Pension Plans, RRSP’s
What happens if a client fails to
provide the information?
 If the client does not provide the information
that the OW office asks for, the client’s
assistance could be cancelled/suspended or
reduced until they do.
 But if the client has made reasonable efforts to
get the information or documents, their
assistance should not be cancelled or reduced.
Third Party Checks
 Third Party Checks include requests from the following:
 Ministry of Transportation
 Equifax (credit check)
 Family Responsibility Office (FRO)
 Canada Revenue Agency (CRA)
 Employment Insurance (EI)
Some Compliance Tools used
are:
The tools used by MCSS to do file audits and to determine continual
eligibility of social assistance in the following categories:
 Initial Eligibility
 Financial Assistance
 Intake Process
 Participation Requirements
 Mandatory Benefits
 Termination/Cancel of Benefits
 Lets take a look at some key
points that each of these tools
contain
Initial Eligibility
 Was the application completed and
signed by all members of the benefit
unit?
 Was all mandatory forms
commissioned?
 Are all required documents on file?
 Are all other documentation been
visually verified and noted on file?
Initial Eligibility
 Is there a Verification Checklist completed and
on file?
 Are there proof of identification of everyone in
the benefit unit?
 Are case notes noted to indicate decisions of
assistance?
Financial Assistance
 Has proper accommodation costs been
verified?
 Were earnings/income declared for all
members of the benefit unit?
 Are there any child/spousal supports
payments?
 Assets
 Northern Allowance
Intake Process
 How was the initial contact noted?
 Has the date of initial contact been dated?
 Was the client notified of all the required
documentation they should bring for their
intake appointment?
 How long from the initial point of contact and
the intake date been?
Participation Requirements
 Was the participant deferred at any time?
 Is there documentation on file do support this
decision?
 Was the Participation Agreement completed and
monitored?
 Are PA’s updated every 3 months?
 Are there PA’s for all adults and dependent adults
in the benefit unit?
Participation continued
 Were there outstanding activities pertaining to
employment assistance?
 Were skills listed consistent with client’s skill
experience, circumstances?
 Were timelines consistent with policy
directives?
 Was Employment related expenses issued?
Participation continued
 Was the client required to do Independent Job
Search?
 Is the client enrolled in Basic Education or skills
training?
 Is there a Literacy Screen Test on file?
 Is the client Self Employed?
 Is the client participating in Community or
Employment Placements?
 LEAP
Mandatory Benefits
 Were there any Mandatory Benefits issued
for any of the following reasons and are all
proper documentation on file?
 Diabetic Supplies
 Medical Transportation
 Vision Care
 Dental Coverage
 Drug Cards
 Community Start Up
 Special Diet
 Pregnancy Allowance
Termination or Cancel of Benefits
 Was appropriate reason stated on file?
 Was it voluntary?
 Is there adequate documentation on file
to support termination/cancellation of
benefits?
 Is there a copy of a closing letter stating
why the file is being closed?
The next few slides show
findings from MCSS
 The areas that need improvement is Non-Compliance.
Here is an example and could have been a cost of recovery
on just two questions.
 Was the application signed by all members of the benefit unit?
 Does the amount for financial assistance issued for shelter reflect
verified actual costs up to the maximum shelter amount?
From these two basic questions the following is the amount that
could have been potential recovery from your community.
What is the most common file errors
made in a File Audit Review?
 Here are a few key factors noted from former
PRO’s : the most common mistakes are:
 Lack of documentation and incomplete documents





like Form 1
Not signed or commissioned.
Sections left unanswered.
Non verified shelter costs.
No receipts
No Case notes that explain decisions made.
Potential Recovery
Number of Sites
Reviewed
Potential Recovery
2007
29
725,790.50
2008
31
676,866.81
2009
11
200,238.91
Was an application
completed and signed
by all applicable
members of the benefit
unit (i.e. applicant,
spouse, dependent
adult ) on file?
Answer No
Does the amount
for financial
assistance issued
for shelter reflect
verified actual
costs up to the
maximum shelter
amount?
Answer No
Total of two
questions
Total
Percentag
e of
Potential
Recovery
2007
185,654.32
$307,351.43
$493,005.75
67.9%
2008
$191,644.92
$394,843.65
$586,488.57
86.6%
2009
$83,304.71
$100,664.82
$183,969.53
91.8%
Scenario #1
Recipient notifies their Caseworker that
his/her rent has increased and is asked to
provide verification of the new rental
amount. Recipient is already receiving the
maximum shelter allowed under Ontario
Works and rent was previously visually
verified and noted on file.
 No. In this example, the recipient is
already receiving the maximum shelter
allowed under Ontario Works and
therefore the shelter allowance would
not be increased. The information is
not essential for determining eligibility
or the accuracy of the entitlement.
Scenario #2
The Caseworker requests verification of
school records for a 10-year old dependent
child. The information is not provided.
 Is the information and/or documentation requested
essential for the determination of eligibility or the accuracy
of the entitlement?
 No. Under the Education Act, it is the
responsibility of school boards to monitor
school attendance and satisfactory progress for
children under the age of 18 and therefore,
school records should not be requested.
 All that needs to be documented on file are
report cards.
 Provide an example of when you would have to
have attendance records on file?
Scenario #3
A recipient reports that his wife has just given
birth to their third child. A review of the file
indicates that no previous information was
provided that the spouse was pregnant. The
recipient is asked to provide birth verification for
the additional dependent. The information is not
provided.
 Yes, The information requested is essential for the
determination of the accuracy of the family’s
entitlement. However, the information is not necessary
to determine the eligibility of the rest of the benefit unit.
 How come? What would be change on the
entitlement?
Continued…
 The client advises the worker that they have
applied to the Registrar General to obtain birth
registration; however, they have been informed that
the waiting period is three months. The client
provides the hospital bracelet for the child and
agrees to provide the notice of birth registration
once it has been received.
 Is this correct? Do you find this situation
acceptable?
Scenario #4
 Belinda is a 59 year old woman who is on
assistance. During the file update and Third
Party Check, it was noticed that she owns
property in the next province that she has not
told you about.
She states the property is runned down and
nobody lives there so she didn’t think she had to
claim it. It is winter and you notice that she has a
hard time walking and needs a walker to assist
her.
 What would you do in this
situation?
Scenario #5
 Sherry is a mother 5 children, but only has 3 in her care. Her
older two children live with her mother and, her mother
receives Temporary Care for them. Sherry has been on and
off assistance for the last 3 years. She constantly moves
from the city to the reserve because of domestic violence.
 Sherry said on her application she receives no child support
from either of the 2 fathers of her children. After doing a file
update and a Third Party Check, you find out that she has
been receiving money from the father of the first 2 children
all along. She was getting $200 a month, and was suppose
to give the money to her mother but she hasn’t. The mother
did not want to get her in trouble so she did no indicate that
she knew she was getting the child support.
 Would you put her in an overpayment or is this
a fraud case and needs further investigation?
What would you do?
Group Work
 Each table will have their own file to work with. Each file
with have its own scenario. You will go through the file to
make sure everything is in order in accordance to the
OW act, Policies and Directives.
 If anything is missing or you feel should be in the file,
please make your file as you would in your First Nation.
 Feel free to design your own documentation as it
pertains to the file. Some may need, identification, rent
receipts, PA updates, etc.
 Afterwards you will pass your file to another
group, and the other group will use the audit
tool to your file to see if it is up to standards
with legislation.