Veterans Affairs Canada Audit of the Federal Health Claims Processing System National Investigative Unit - October 2012
The Federal Health Claims Processing System is the automated system that processes health claims for Veterans Affairs Canada, the Department of National Defence and the Royal Canadian Mounted Police. To administer this large and complex system, Public Works and Government Services Canada contracts the services of a private health insurer, Medavie Blue Cross. Of the three departments, Veterans Affairs Canada is the largest user accounting for 87% of the total volume of claims processed. In 2010/11, there were 13.5 million claims processed for Veterans Affairs Canada at a value of $640 million.
To protect the financial integrity of the claims processed, Medavie Blue Cross is contractually obligated to conduct investigative services of the 170,000 health care providers registered to deliver benefits or services to Veterans. The National Investigative Unit, within Medavie Blue Cross, conducts various audit activities to ensure that the health care providers are complying with the requirements. These activities include:
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analyzing claims data to identify providers whose billing practices may not comply with the requirements;
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distributing letters to Veterans to verify that benefits and services billed were actually received;
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mail audits requesting providers to submit additional documentation to support a claim submitted; and
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on-site audits where investigators will travel to the health care provider's business to meet with the staff and review the supporting documentation on location.
The purpose of these audit activities is to identify potential recoveries, educate health care providers on the billing requirements and act as deterrent to improper billing practices.
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Additional Info
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| Last Updated | October 20, 2025, 03:39 (UTC) |
| Created | October 20, 2025, 03:39 (UTC) |
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Domain / Topic
Domain or topic of the dataset being cataloged.
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Title
Title for the Dataset.
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Veterans Affairs Canada Audit of the Federal Health Claims Processing System National Investigative Unit - October 2012 |
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Description
A description of the dataset.
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The Federal Health Claims Processing System is the automated system that processes health claims for Veterans Affairs Canada, the Department of National Defence and the Royal Canadian Mounted Police. To administer this large and complex system, Public Works and Government Services Canada contracts the services of a private health insurer, Medavie Blue Cross. Of the three departments, Veterans Affairs Canada is the largest user accounting for 87% of the total volume of claims processed. In 2010/11, there were 13.5 million claims processed for Veterans Affairs Canada at a value of $640 million. To protect the financial integrity of the claims processed, Medavie Blue Cross is contractually obligated to conduct investigative services of the 170,000 health care providers registered to deliver benefits or services to Veterans. The National Investigative Unit, within Medavie Blue Cross, conducts various audit activities to ensure that the health care providers are complying with the requirements. These activities include:
The purpose of these audit activities is to identify potential recoveries, educate health care providers on the billing requirements and act as deterrent to improper billing practices. |
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Tags / Keywords
Keywords/tags categorizing the dataset.
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Format (CSV, XLS, TXT, PDF, etc)
File format of the dataset.
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Dataset Size
Dataset size in megabytes.
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Metadata Identifier
Metadata identifier – can be used as the unique identifier for catalogue entry
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Published Date
Published date of the dataset.
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2012-10-31 |
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Time Period Data Span (start date)
Start date of the data in the dataset.
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Time Period Data Span (end date)
End date of time data in the dataset.
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GeoSpatial Area Data Span
A spatial region or named place the dataset covers.
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Access category
Type of access granted for the dataset (open, closed, service, etc).
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License
License used to access the dataset.
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Open Government Licence - Canada |
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Limits on use
Limits on use of data.
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Location
Location of the dataset.
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https://open.canada.ca/data/en/dataset/f31fce6e-f2b2-44e1-8a08-d3e901fba175 |
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Data Service
Data service for accessing a dataset.
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Owner
Owner of the dataset.
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Veterans Affairs Canada | Anciens Combattants Canada |
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Contact Point
Who to contact regarding access?
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Contact Point Email
The email to contact regarding access?
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Publisher
Publisher of the dataset.
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Publisher Email
Email of the publisher.
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[email protected] |
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Author
Author of the dataset.
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Author Email
Email of the author.
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Accessed At
Date the data and metadata was accessed.
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Identifier
Unique identifier for the dataset.
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Language
Language(s) of the dataset
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Link to dataset description
A URL to an external document describing the dataset.
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Persistent Identifier
Data is identified by a persistent identifier.
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Globally Unique Identifier
Data is identified by a persistent and globally unique identifier.
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Contains data about individuals
Does the data hold data about individuals?
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Contains data about identifiable individuals
Does the data hold identifiable data about individual?
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Contains Indigenous Data
Does the data hold data about Indigenous communities?
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Portal Type
Platform type of the source portal.
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Version
Version of the datatset
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None |
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Source
Source of the dataset.
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None |
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Version notes
Version notes about the dataset.
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Is version of another dataset
Link to dataset that it is a version of.
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Other versions
Link to datasets that are versions of it.
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Provenance Text
Provenance Text of the data.
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Provenance URL
Provenance URL of the data.
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Temporal resolution
Describes how granular the date/time data in the dataset is.
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GeoSpatial resolution in meters
Describes how granular (in meters) geospatial data is in the dataset.
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GeoSpatial resolution (in regions)
Describes how granular (in regions) geospatial data is in the dataset.
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Indigenous Community Permission
Who holds the Indigenous Community Permission. Who to contact regarding access to a dataset that has data about Indigenous communities.
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Community Permission
Community permission (who gave permission).
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The Indigenous communities the dataset is about
Indigenous communities from which data is derived.
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Number of data rows
If tabular dataset, total number of rows.
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Number of data columns
If tabular dataset, total number of unique columns.
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Number of data cells
If tabular dataset, total number of cells with data.
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Number of data relations
If RDF dataset, total number of triples.
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Number of entities
If RDF dataset, total number of entities.
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Number of data properties
If RDF dataset, total number of unique properties used by the triples.
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Data quality
Describes the quality of the data in the dataset.
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Metric for data quality
A metric used to measure the quality of the data, such as missing values or invalid formats.
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