Control Structure

1. All staff in the Department are concerned with the prevention of incorrect payments and the detection of fraud and abuse of Social Welfare schemes. Day to day control activities are carried out by staff involved in the processing and payment of entitlements and in investigation units which operate at local and regional level.

Control Division

2. Control Division was established to give the control function a higher profile in the Department. The Division's role is non executive; it has no involvement in the day to day activities of achieving control savings.

Its function is to:

• promote control as an essential element of the Department's overall responsibilities
• monitor the control function across the Department
• co ordinate and report on all control activities in the Department
• evaluate the benefits of control activities undertaken
• identify new areas of possible activity
• liaise with other organisations on control issues

Regional Structure

3. The introduction of the regional management structure has facilitated:

• a more co ordinated approach to the control of social welfare schemes
• greater efficiency in the use of control resources
• an increase in the level and nature of employer inspections
• better selection of cases for review
• the measurement of control savings against specific targets

Scheme Control Units

4. As part of the more focused approach to control, each scheme section has set up a dedicated Control Unit which:

• co ordinates all control activities within their respective areas
• sets and agrees annual/monthly targets monetary and the number of cases for review
• initiates and undertakes various control activities
• reviews the effectiveness of various control initiatives
• produces monthly returns
• liaises with Regions and Control Division.

Investigative Units

5. Investigative staff carry out a wide range of control duties which include

• processing and reviewing means tested claims
• reviewing entitlement of recipients
• carrying out employer inspections
• investigating fraud and abuse

Activation and Control Teams (ACTs)

6.Local Area Control Teams were established for each of the Department's Local Offices. These teams, under the local Area Manager, co ordinate all the activities and resources in relation to the control of the Live Register at local level. They ensure that all control activities, established and new, are being vigorously applied and augment them with particular approaches based on local knowledge and circumstances.

Control Activities

7. All day to day control activities are carried out at regional, local, or scheme level and are recorded in accordance with the guidelines on determining control savings.

Summary

1. Introduction

The Control Strategy of the Department has been reviewed and a revised version launched. It updates and supersedes a strategy in place since the 1990's

The main objective of the new controls strategy is to provide a clear statement of the department's approach to the control of fraud, abuse and error.

It will establish a control framework where:

• there is an anti fraud culture and a high level of control awareness
• all staff have a responsibility for control
• control is a key element of service delivery
• control is accepted as an intrinsic part of all claim processes
• there is a specially focused effort to deal with fraud, abuse and error
• there is a specific control approach for each scheme
• overpayments are a debt to be recovered
• data is a resource to be maintained and protected
• legislation is continuously reviewed and updated to strengthen controls and penalties
• cases involving fraud or abuse of the social welfare system are examined with a view to initiating legal proceedings

An effective control programme sits alongside the provision of the highest quality service to our customers.

We have a broad ranging and comprehensive control strategy, which aims to keep fraud and abuse to a minimum. Our emphasis therefore is to minimise risks of fraud and eliminate incorrect payments.

This involves checks at point of claiming, reviews of means, verification that the conditions for entitlement continue to be met, medical reviews, inspection of employers for compliance, arrangements for debt recovery and prosecution of offenders.

In the control and delivery of a service context, the objective is to ensure that the department pays the right person the right amount at the right time.

The approach to reaching this objective can be summarised as follows:

• prevention having systems and procedures in place that prevent and minimise the risk of fraud, abuse and error
• detection detecting fraud, abuse and errors at the earliest possible stage, and detecting unpaid PRSI contributions by employers and the self employed
• deterrence to develop an anti fraud culture among staff and the public by ensuring that the public is aware of the risks and penalties of defrauding the Social Welfare system and dealing decisively with cases of fraud and abuse detected
• debt recovery to actively pursue the recovery of all debts

Control is a key element of service delivery

There is no contradiction between exercising satisfactory control and delivering good customer service

Everyone involved in the administration of the various schemes should be aware of the need to implement appropriate controls at every stage of the process. The control process should be an integral part of the day to day operations and should be so integrated as not to affect the capability of the service to respond to needs.

Control should be commensurate with risk

It is important that the level of control work be commensurate with the risk involved there is little point in expending considerable resources on control of a scheme where there is virtually no risk of fraud or error. Therefore, in drawing up specific procedures and activities for schemes, an objective risk analysis should be carried out to determine the main risks of fraud and error.

Control procedures should relate to the perceived risk of fraud, error or other loss and should be regularly reviewed for effectiveness. These procedures should also be cost effective.

Such risk assessments should be conducted periodically across all functions to provide and maintain an up to date picture of the Department's fraud and error risk profile.

Control Division will be providing support to Managers undertaking these assessments.

All staff involved in administering schemes should be aware of and understand the Department's strategy in relation to control of fraud, abuse and error.

Staff should understand the processes and procedures in the schemes they operate and their own roles in the process of scheme administration and be aware that they have responsibilities for following procedures, guidelines and controls.

Management and staff should be aware of the obligation to consider instances of fraud for prosecution and the Department's policy and guidelines in this respect.

Everybody has a role to play

We are all responsible

It is essential that all data held by the Department is of a very high quality so as to ensure that:

• up to date data is available when needed
• claims and applications are processed in an effective and efficient manner
• the correct decisions are made
• payments and correspondence are sent to the correct address
• control effort is maximised
• effective use can be made of the data for checking and data matching etc
• review activity can be targeted, based on accurate data
• overpayments are prevented because payments are based on accurate data

Staff must ensure that, at every contact with a customer, whether at initial claim stage or at various stages in the claim life cycle, key information is checked and updated as necessary