Appendix B - Methodology
| Methodology | Purpose |
|---|---|
| Interviews | Interviews were conducted with VAC staff in program management, policy, health professionals and research. Interviews were also held with research experts in the area of CMP and with the third-party health care practitioner managing the CMP claims for VAC. Interviews were conducted to gather information about the program and its activities, to ensure proper understanding of application of controls, and to validate audit observations. |
| Documentation Review | Documentation reviews were conducted supporting the audit’s objectives. The audit team examined policy documents, business process documents, applications and claims. An environmental analysis was conducted including national and international research and media articles. Industry practices were also examined taking into account guidelines and policies within the health industry and the insurance industry regarding CMP. |
| File Review | Two separate file reviews were conducted to assess controls over applicant assessments, payments, and monitoring activities. The file reviews included both approved and denied applications. |
| Data Analyses | Data available was reviewed and analyzed for trends in growth, authorizations, authorizers, contraindications of disability benefit entitled conditions and drug usage. |