Audits

General Information

• Veterans Affairs Canada, its agent Blue Cross, or its legally appointed representatives reserve the right to examine and copy all data and documentation relating to any claim previously paid or outstanding for payment.
• As a participating provider, you are responsible for gathering and retaining documentation in accordance with the laws of your province/territory and those of Revenue Canada pertaining to the retention of health records.
• During the course of an audit, Blue Cross will notify you, in writing, if it disagrees with, or adjusts, your claim for payment.

Audit Response Procedures

• You will be given a maximum of fifteen (15) working days from the date the letter has been sent, to review and respond to the audit findings.
• In your response, you may submit new or additional information pertaining to the claim. You may also dispute any or all discrepancies that have been identified.
• Responses must be forwarded to:

  The Investigative Unit
  Blue Cross of Atlantic Canada
  P.O. Box 220
  Moncton, N.B.
  E1C 8L3

• The information submitted will be reviewed by Blue Cross. Where appropriate, adjustments may be made to the audit findings.
• Blue Cross will notify you, in writing, of the audit decision.

Audit Outcomes

Actions resulting from audits can include, but are not limited to, any of the following:

• cancellation of your Provider status;
• suspension of your Provider status;
• re-installment of your Provider status;
• criminal prosecution;
• civil litigation;
• recovery of deficient amounts, either directly from the Provider or from withheld claims payments;
• negotiated repayment options;
• referral to an appropriate licensing authority for investigation; and
• no further action.

Requesting a Review

You may request a review of the outcome of a VAC Audit by writing to:

Veterans Affairs Canada
P.O. Box 7700
Charlottetown, PE
C1A 8M9
Attention: National Manager, Health Benefit Delivery

• All requests for review of the outcome of a VAC audit must be submitted with fifteen (15) working days of the date the letter was sent to you.
• Results from a request for a review will be communicated to you in writing.
• These results are considered to be final by VAC, however, they will in no way interfere with your ability to pursue legal recourse.