3.1.1.1 — A possible overpayment may be detected by the discovery of a discrepancy between new details obtained by DVA and the current financial and domestic circumstances held in the pension assessment.
3.1.2.1 — Discrepancies may be brought to the examiner's notice by such things as:
These are discussed in the following sections of this chapter.
3.2.1 — Often an overpayment will be detected after the pensioner advises of a change in his/her circumstances. For example, if the pensioner advises that he/she has just purchased a property, and there is no corresponding reduction in other assets, the examiner should query the source of the funds used for the purchase. This may lead to detection of an overpayment as a result of previously undeclared assets and/or income.
3.2.2 — Examiners should ensure that the current assessment is correct prior to commencing overpayment action to reduce the possibility of a further overpayment occurring. Simple overpayments occurring after a date of effect change in circumstances are raised automatically when the change is coded in PIPS. These debts are automatically transferred to DMRS. DMRS automatically commences withholding action to recover the debt, unless the client is no longer in payment or if the overpayment is in excess of $5,200. If the client is no longer in payment or the overpayment is in excess of $5,200 the case is referred to the Overpayment Management Unit for manual recovery action to be initiated.
3.2.3 — Where the overpayment is too complex for automatic raising and recovery, e.g. it occurred over a long period of time the case may need to be referred to the State OMU.
3.2.4 — Any client advice of changed circumstances which uncovers or produces a discrepancy between the new situation and the previously held details, should be examined carefully to ensure that any possible overpayment is detected.
3.3.1.1 — Under the authority of section 54A [8] VEA, the Department may periodically issue a prescribed review form to any service pensioner - Statement of Circumstances D2589.
3.3.1.2 — As with PIRs, discrepancies between the new details and the details currently held in the assessment may lead to detection of an overpayment. This also applies to cases where the income support payment is to continue at the current rate or at the maximum rate of payment where information provided may highlight changes not previously notified - e.g. periods of employment, or withdrawals from managed investments where no managed investment had been previously recorded.
3.3.2.1 — In June 2003, the Income Support Review Program was implemented. Specific review is a term chosen to define a range of circumstances for periodic re-assessments by the Department. Examples include earnings, aged care admission, post bereavement and change of address reviews. Analysis of the review process through the Specific Issue Review (SIR) Project found that many of these reviews were not being conducted in accordance with policy, and as a result significant groups of pensioners were at risk of being paid the incorrect rate of pension. As a result, nationally agreed guidelines and procedures were produced for the conduct of SIRs in all States.
3.3.2.2 — The Income Support Review Program Guidelines and Procedures for Specific Reviews Manual may be obtained via Part 12 Chapter 7 of the CLIK Procedure Library. The manual contains:
3.3.3.1 — Other types of departmental initiated reviews include compliance reviews, departmentally initiated review exercises, automatic processing runs and data matching.
3.3.4.1 — Compliance reviews are nationally coordinated exercises targeting assessment of high-risk characteristics. For example, assets tested cases or assessments with real estate that has not been valued for many years. In the 2003-04 Budget, the Federal Government announced funding for an Enhanced Compliance Program to be implemented from April 2004. It is estimated that 10,000 reviews will be conducted each year through the Departmental Review System, which will semi-automate review processes for form generation and provide improved monitoring and reporting. The reviews will be comprehensive in updating all personal, residential and financial information.
3.3.5.1 — Departmental review exercises include reviews of pensioners' personal and financial information initiated at a national level. These include annual property revaluations by DVA's licensed valuer and annual allocated pension reviews.
3.3.6.1 — Periodic automatic processing runs update aspects of pensioners' financial circumstances including:
Note:From 2004 automatic indexation only occurs to UK Government pensions. UK DSS pensions will be processed manually from this date.
Cases that cannot be processed automatically are identified for manual review action in State Offices.
3.3.7.1 — The data matching program involves computerised matching of identity and income data held by various government agencies. Current matching programs include:
In all cases, current records should be updated before any overpayment action is taken.
3.4.1.1 — Overpayments may be detected as a result of information supplied by a source other than the client.
3.4.1.2 — This information can be received in the following ways:
3.4.1.3 — Advice from a third party is usually in response to a departmental questionnaire or may be provided to the Department at the client's request. Under section 128 [8] VEA, the Department has the authority to request information required in connection with a pensioner's assessment from third parties such as financial institutions, employers, relatives, or any other person. The pensioner's authorisation to release such information is not required and there are penalties for failing to comply with the request or for supplying false or misleading information.
3.4.1.4 — To comply with the provisions of the Social Security (Administration) Act 1999 (SSAA) concerning disclosure of information to DVA, the Chief Executive Officer of Centrelink, having been delegated powers by the Secretary to the Department of Family and Community Services, issued a certificate under subparagraph 208(1) (b)(i) of the SSAA. The certificate specifies the disclosure of protected information to the Secretary of the Department of Veterans' Affairs, by those employees of Centrelink specified in the certificate. It should be noted that Centrelink will not provide any information outside the areas specified in this certificate. The current certificate of disclosure may be obtained from the CLIK Reference Library.
3.4.1.5 — Advice from a third party should be carefully compared with existing records to ensure that any discrepancy is detected and acted upon. If a reduction in rate is likely to occur, reassessment action must be taken as soon as possible to minimise any resulting overpayment.
3.4.2.1 — Under the VEA the Commission may approve payment of pension to agents and trustees who act on behalf of the pensioner. A detailed description of agents and trustees may be obtained from P11/C3 of the CLIK Policy Library.
3.4.2.2 — Trustees have a legal right to receive and retain pension payments, but also must fulfil any obligations imposed on the pensioner under the VEA. While an agent may receive payments on the pensioner's behalf, they are under no obligation to notify of a change in circumstance. Obligations imposed under the VEA remain with the pensioner.
3.4.2.3 — With effect from 1 July 2003, changes were made to the social security law (SSL) in relation to payment and correspondence nominees. Income support staff need to be aware of the SSL changes when dealing with DVA age pensioners. The legislative changes are contained within the new Part 3A of the Social Security Administration Act 1999 (SSAA) which can be accessed through ComLaw.
More ? [18]
Under the new legislation nominee arrangements have been refined to:
3.4.2.4 — Correspondence nominees are authorised by the pensioner to receive correspondence on their behalf and are nominated to assist the pensioner in their dealings with DVA, including fulfilling reporting obligations. If a nominee fails to report relevant changes to DVA then the recipient is taken to have failed in their obligations. For example, any debt incurred remains the responsibility of the pensioner.
3.4.2.5 — A payment nominee (who can be an individual or body corporate) receives a payment on the pensioner's behalf. A payment nominee may have access to minimal protected information for the purposes of administration of the payments. A payment nominee must keep a record detailing the particulars of the disposal of the payment/s. Penalty provisions may apply if the nominee fails to comply with a request to provide disposal records.
3.4.2.6 — VEA agents are not subject to the same penalty provisions as SSL payment nominees. Any obligation imposed under the VEA to notify the Department of an event or change of circumstance remains with the pensioner.
3.4.2.7 — Full guidelines relating to SSL nominees are contained at 8.5.3 of the Guide to Social Security Law.
More ? [19]
Guide to Social Security Law – 8.5.3 Responsibilities of Nominee
http://www.fahcsia.gov.au/guides_acts/ssg/ssguide-8/ssguide-8.5/ssguide-8.5.3.html [22]
3.5.1.1 — A denunciation is information provided to the Department, alleging that a client is receiving a benefit to which he or she is not entitled, and/or is providing false or misleading information to the Department. Denunciations should be handled with extreme care, for they imply that a pensioner has not complied with his or her obligations to the Department.
3.5.1.2 — There are several methods by which people make denunciations to the Department. These include:
3.5.2.1 — When a person discloses information to the Department, every effort should be made to have the informant provide his/her name and address. Informants are not obliged to give their name and address, but they should be advised that if they do so, the Department does not disclose personal information unless authorised under the Privacy Act 1988.
3.5.2.2 — The informant can be advised that in the event of a request for their personal details it would be processed in accordance with the provisions of the Freedom of Information Act 1982. Under section 27 of the Act, the Department would have to consult with an informant prior to making any decision to grant access to any documents containing personal information about them.
3.5.2.3 — It may not always be possible to exempt information from an FOI request relating to pensioners who are the subject of a denunciation. However, access to information relating to informants is likely to be refused under various exemptions, depending on the circumstances. The exemptions include:
3.5.2.4 — If the informant inquires about the outcome of departmental investigations, it should be explained that the Privacy Act 1988 prohibits giving information about pensioners to third parties where the pensioner has not authorised the disclosure. However, the informant can be told that the Department takes all allegations seriously and will investigate and act on those found to be correct.
3.5.2.5 — When responding to an informant a general statement such as the one below may be used:
Thank you for the information you have provided. All allegations are fully investigated. Where allegations are substantiated, action is taken. However, because of the strict requirements of the Privacy Act 1988, I cannot provide you with information about the results of any action taken.
3.5.2.6 — Officers dealing with denunciation cases must ensure that any access to information is processed under the FOI Act to protect the anonymity of the informant. It should be remembered that any requests for access to information in documentary form should be passed to the FOI Section for attention. It should also be remembered that careful perusal of documents will be necessary to determine which, if any, can be exempted. Personal information about the informant may be identifiable without a name or signature. The Privacy Act 1988 defines personal information as: information or an opinion (including information or an opinion forming part of a database), whether true or not, and whether recorded in a material form or not, about an individual whose identity is apparent, or can reasonably be ascertained, from the information or opinion.
For example, someone who describes him/herself as 'neighbour' may readily be identifiable without a name and address.
3.5.2.7 — If a pensioner asks whether the Department is conducting an investigation into his/her affairs, we cannot deny that we are making inquiries. The pensioner may be advised of the allegations that have been made, providing that the informant is not identified. However, it is not necessary to inform the pensioner of the investigation, or the reason for it, unless asked.
3.5.3.1 — The Department has an obligation to investigate all allegations. Some more common reasons for denunciations are a veteran's fitness for work, relationship status, undisclosed income/assets, residency, eligibility for payment in respect of dependent children and eligibility for rent assistance.
3.5.3.2 — If the information is provided at the counter or over the telephone, it is important to obtain as much relevant information as possible. Anyone approaching the Department with information should be encouraged. Without pressuring the informant, sufficient information must be obtained to correctly identify the pensioner concerned and the cause(s) of any possible overpayments.
3.5.3.3 — When taking a telephone call from an informant:
3.5.3.4 — If information is provided in writing it may be necessary to contact the person who provided the information (if possible) and for further information or clarification. Care should be taken with written information. Notations should not be made on the correspondence and it should always be filed, preferably with a plastic sleave, regardless of whether there is any further action.
3.5.4.1 — Undisclosed Employment
It is important when collecting information on employment to get enough detail to be sure this is not occasional employment. A good description of the type of work, the hours and days worked and when the person started work would be significant information with regard to income. It may be that the person had only a few hours work for a very short period and the estimated earnings would be too small an amount to have an effect on the rate of service pension. Additional information describing in detail the type of work being undertaken would be significant in the case of a Special rate or temporary payment at special rate pensioner.
3.5.4.2 — Undisclosed de facto relationship
In cases of undisclosed marriages or de facto relationships it would be useful if questioning could help eliminate the possibility of people such as relatives, lodgers and boarders being incorrectly identified as the 'partner'.
3.5.4.3 — Undisclosed income/assets
Undisclosed assets could include a boat or holiday home, and information on the whereabouts and acquisition date of the assets would be useful. Disposal of assets may be a case of deprivation. Accusations of undeclared income could result from remarks made about the performance of shares and the market in general, about purchases or plans made as the result of a compensation payment. If a discrepancy exists between the denunciation and the pensioners pension assessment, an income and assets statement should firstly be sent to the pensioner before further investigative measures are conducted. Detailed information about accounts, numbers and types of shares etc may need to be investigated further and would be released by financial institutions only on a request made under section 128 [8] VEA.
3.5.5.1 — The denunciation should be handed to the appropriate office or area in your section. If your section has designated officers to handle denunciations the case should be handed to them for action. State Office procedures should be followed with regard to responsibility and clearance for the various stages of the investigation.
3.5.5.2 — Once a pensioner has been correctly identified, all details in the denunciation should be compared with the current records. The first step should always be to check the Department's records with the information received. This includes checking when the last advice was sent to the pensioner and what it said in regard to obligations, and whether this pensioner is subject to automatic review.
3.5.5.3 — It must also be determined when the pensioner was last reviewed. If it was only recently, then it would be appropriate to go ahead and investigate further. If it was some time since the last assessment, the pensioner should be reviewed again before a decision is made to continue investigating the allegations. This gives the pensioner the opportunity to come forward and notify of a change of circumstances. It may be that there are extenuating circumstances which explain why the information was not immediately relayed to the Department.
3.5.6.1 — Any information collected must be in accordance with the Information Privacy Principles and DI B48/92. Collection of information must be justified as being correct and relevant under the Privacy Act 1988.
3.5.6.2 — Some information is readily available, commercially or publicly without a formal request under section 128 [8] VEA. There may be some variation from State to State, but generally the sources would include the Electoral Office, Motor Vehicle Registry, the Land Titles Office and possibly the Registrar Generals Office. Some of these offices will give a government department, termed a prescribed authority, access to do their own search. Most require a letter from the Department authorising and identifying the officer.
3.5.6.3 — The information available from these sources includes full name and address, date of birth, occupation, ownership of property, mortgages, details of motor vehicles owned and disposal of previously owned motor vehicles. Information on births, deaths and marriages, company registrations etc held by the Registrars Office may not be available in some States except to members of the family or their solicitor.
3.5.6.4 — If there is any doubt that in the process of the search, information identifying the pensioner may be given out, it is essential to conduct the search under section 128 [8] VEA. To divulge any information which would identify a pensioner is a breach of the Privacy Act 1988. Section 128 [8] VEA requests should be employed to protect the Department rather than to force a third party to divulge information. When the information can be obtained without divulging to a third party any information which would identify the pensioner, a section 128 request is not required.
3.5.6.5 — Investigations should be continued until the examiner is satisfied that sufficient information has been obtained to make a decision on whether further action is required. The outcome of the investigation should be documented and filed.
3.5.7.1 — Employment
If the alleged employer is a large organisation, a phone call to the personnel area may be sufficient to confirm the pensioner is employed there. Details of the employment should then be obtained with a formal request under section 128 [8] VEA. If there is any suggestion that the pensioner may be working under a different identity, advice should be sought immediately from the National Fraud Control Unit (NFCU).
3.5.7.2 — Rent Assistance
If an informant claims a pensioner is being paid rent assistance when in fact he/she owns (or partner owns) the house in which they are living, the first step would be to check the files to see to whom the claimed rent is being paid. This could be an individual, a real estate agent, a private trust or a private company. A title search with the Land Titles Office will reveal who owns the property. The local council (or appropriate authority in the State) will know to whom the rate notices are sent. In relation to a private company or trust, the status of the pensioner as an attributable stakeholder would need to be determined.
3.5.7.3 — A pensioner could be accused of claiming rent assistance when they were not paying rent but were actually living either in a defacto relationship or simply rent free. The landlord should be able to produce a record of rent received. It should also show on the taxation records of the landlord. If a defacto relationship is uncovered in the process of investigation, there may also be, in addition to the rent question, a need to follow up on details relating to the partner's income/assets.
3.5.7.4 — Marriage or Marriage-Like Relationship
One reason to hide a marriage would be that the veteran's partner has income or assets that would affect the pension, or because both partners have been receiving pension at the single rate. The first step would be to confirm that the couple are living together and that the partner is clearly identified as not being a relative (parent, brother, sister, son or daughter).
3.5.7.5 — The name of the partner will need to be obtained. If enough details are available the Registrar's Office can confirm a marriage. If a name is available, a match can be made by checking with the Electoral Roll, the Motor Vehicle Registry, employer, landlord or real estate agent. An interview may be conducted with both parties in order to ascertain the relationship as described in section 11A [8] VEA. Alternatively the pensioner and partner may be requested to complete a statement or questionnaire outlining the factors described in this manual's Section 3.5.7.6
3.5.7.6 — In forming an opinion about the relationship of the couple, the following matters (which are described in more detail in section 11A [8] VEA), are to be considered:
3.5.7.7 — Dependent Child
To qualify as a dependent child it is not necessary that the child be living with the pensioner, so their absence from the pensioner's home is only significant if the pensioner has claimed they do live together. Information previously given by the pensioner as to the children's school would be a good starting place. If there is a suggestion that the child or children do not exist, then the birth register should be checked if enough information is available to begin a search. A pensioner claiming dependent children from DVA is also likely to be receiving benefits for those children from Centrelink, and the ATO should also have details.
3.5.7.8 — Undisclosed Income/Assets
It is essential to have details of income and the financial institutions involved, or details of the financial adviser handling the pensioner's affairs, to make inquiries concerning income. Assets may be more easily investigated, particularly if they are property (land titles and council), motor vehicles or boats (registry).
3.5.8.1 — Having reviewed the pensioner's circumstances, made further investigation and gathered information under section 128 [8] VEA from third parties, the examiner may decide to interview the pensioner. The guidelines for interviewing are contained in this manual's Chapter 11 Overpayment Interviews.
3.5.8.2 — Where the new details confirm that a variation in pension is warranted, examiners should establish if there is a breach of section 54 [8] VEA obligations. For an automatic decision to vary pension under section 56 [8] VEA, section 56A [8] VEA or section 56B [8] VEA, the date of effect rules apply. If the decision to vary pension is an adverse determination, the date of effect is determined by the delegate under section 56H [8] VEA.
3.5.8.3 — Reassessment action should be undertaken as soon as possible to minimise any possible overpayment. The delegate must determine the appropriate action and advise whether variation from an earlier date is indicated by the information provided.
3.5.8.4 — Possible overpayments should be referred to the Overpayment Management Unit who will take investigation and recovery action and determine whether or not the case should be referred for prosecution action.
3.6.1 — Overpayments may be detected as a result of data matching exercises. Data matching involves the comparison of client information collected from government departments with the purpose of strengthening fraud control measures.
3.6.2 — Some of the government departments/agencies with which DVA conducts data matching include:
Data matching exercises are generally conducted in regular cycles, occurring at different periods for different departments.
3.6.3 — Where there is an identity match, the information is checked and the relevant details are compared. If a discrepancy exists, overpayment investigation is then undertaken. For example, if a pensioner has advised DVA that he/she has no income but has declared taxable income to the ATO, it is likely that an overpayment has occurred.
3.6.4 — The DVA Data Matching Program Clerical Procedures Manual sets out in detail the data matching process and how overpayments may be detected as a result. The information compared includes personal details and tax file numbers. There are strict time limits within which action must be taken if overpayments are detected as a result of data matching - these are set out in the Clerical Procedures Manual. The Clerical Procedures Manual may be obtained from the Compliance and Review Section, Income Support, National Office upon request.
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