Employment Insurance whistleblower suspended without pay

[Michael Hardner]

The concept isn't sound for the reasons I said. It's based on an ecological fallacy. You're saying it's necessary based in some hypothetical claims adjuster that has zero denials in a year. First, you've picked that timeframe randomly and second, no one has shown any statistics about the number of truly fraudulent claims. How do we know fraud is so widespread and rampant? Maybe it's reasonable or even possible not to have any rejections. If people are doing their paperwork correctly they shouldn't need to reject people. The important point is that it's their job already to make sure people aren't defrauding the system. A "target" in that context is meaningless. If an employee isn't doing his or her job right, that's a job training issue, not a reason to make up some number of claims that need to be turned down.

I have picked all my numbers randomly, only to show that there is some number. Fraud doesn't have to be 'rampant' in order to be investigated as part of the processing process, it only has to exist and not cost more to discover than it costs the system.

The 'target' is what helps management determine if they're doing their jobs correctly or not.

[carepov]

No. I don't agree that this is a serious problem. Could you show me what evidence you have that there is a serious problem with fraudulent EI claims, such that the entire system needs to be revamped? What proportion of claims are fraudulent? How many claims is that versus the number of claims that are made in a year? How many of those fraudulent claims are honest mistakes filling out the paperwork and doing the reporting?

Well, the first sign that thereis a problem with fraud is that every investigator is expected to save $500,000 per year.

"EI fraud threatens the effective operation of one of Canada 's most important social programs. Our investigations reveal that fraudulent claims result in approximately $142 million in EI overpayments and approximately $61 million in penalties on average each year." http://www.servicecanada.gc.ca/eng/ei/fraud/fraud_serious.shtml

"In 2011–12, the department processed 2.9 million claims and paid out $16.1-billion in benefits.

While the government knows it overpaid $295-million, it also recognizes that it hasn’t yet identified all the mistaken payments. Estimating those could be worth as much as $578-million, the report found." http://www.theglobeandmail.com/news/politics/ottawa-needs-to-crack-down-harder-on-ei-fraud-auditor-general/article11629844/

Your turn: can you show me what evidence you have that setting targets for EI inspectors creates a serious problem for legitiamate EI claimants?

[carepov]

There is no validity to the quotas. Intellectually they are an ecological fallacy. If they need to recoup 10% of the claims made, then what do they do? Pick one out of every 10 claims they receive and deny them? Do they deny all the claims they get every 10th day? It makes absolutely no sense. Claims need to be dealt with on a case-by-case basis, not on a macro statistical level. This is bad statistics, where the government is working backwards. The numbers are supposed to give them a picture of what is going on out there. What you're not supposed to do is try to make what's going on out there fit the numbers. If those numbers aren't where they want them to be, then they need to address the root of the problem that's causing the numbers to be so high. It's like the show The Wire, where they have an opportunity to bust high-level dealers, but for political reasons and in order to make the numbers look better, the brass focuses on street rips, potentially jeopardizing the bigger case that's being worked on. It's a piss poor use of stats.

Perhaps the targets are set based on achievements of investigators in previous years?

Also, don't forget, there is an appeal process and I would assume that every investigator has a goal of 100% accurate and fair rulings, in other words a 0% rate for decisions overturned on appeal.

[Topaz]

First of all, didn't the Tories make changes to the EI and making it harder to collect EI? Secondly, if people pay into EI and can't collect, why are they paying? Thirdly, since they do pay into, wouldn't it be better for them to collect EI rather than go on welfare, which then hit all of us. That's one thing about this government, they don't care about forcing people on welfare, which is covered under the provinces and they said the same thing about changes to CPP, let them go on welfare until they can get CPP.

[cybercoma]

I have picked all my numbers randomly, only to show that there is some number. Fraud doesn't have to be 'rampant' in order to be investigated as part of the processing process, it only has to exist and not cost more to discover than it costs the system.

The 'target' is what helps management determine if they're doing their jobs correctly or not.

You're arguing against something I never said when you say "fraud doesn't have to be 'rampant' in order to be investigated." No one is arguing that insurance fraud doesn't need to be investigated. I'm arguing that the logic behind quotas and targets is faulty and that it creates an environment where rejecting valid individual claims is encouraged to meet goals created from meta data.

[Michael Hardner]

I'm arguing that the logic behind quotas and targets is faulty and that it creates an environment where rejecting valid individual claims is encouraged to meet goals created from meta data.

The logic is time tested and in common practice for all aspects of business, especially customer service and claims processing. The difference between targets, goals, and quotas is how they're managed and that is where the abuse comes in.

Poor managers use statistics poorly, don't you know... No surprise there. And political masters tend to act in such a way as to shield their posteriors from the dull blunt instrument of the press.

[hitops]

Their job is to root out fraud. They need another incentive to do their job? That's like saying cops need an incentive to stop crime, otherwise they'll collect a paycheck and ignore it.

Cops have accountability, they work in pairs or get calls from the dispatcher, or have to respond directly to somebody making a complaints. Fraud workers do not, they work individually pushing paper reviewing files. If they decide to ignore something, nobody else would ever be aware of it.

Oh and btw....cops have.....gasp......quotas! I guess according to you, their work is now invalid.

Edited July 24, 2013 by hitops

[Bryan]

Oh and btw....cops have.....gasp......quotas! I guess according to you, their work is now invalid.

Those quotas (...er ...targets) are driving proper police work. When a cop is told to go and write 50 speeding tickets, s/he is not supposed to write tickets to random people. Police departments know that hundreds (if not thousands) of people are speeding each day along that officer's route, all he has to do is be dilligent enough to catch 50 of them.

The EI targets are the same thing. Millions upon millions of dollars are being defrauded each year. That investigator was tasked with finding a fraction of that, but she balked at the idea of actually having to investigate. She didn't think she'd have to call people? Or actually leave the office once in a while? And she's got the nerve to not only complain, but to leak information she signed a confidentiality agreement on? Seriously, she should be fired.

[cybercoma]

The logic is time tested and in common practice for all aspects of business, especially customer service and claims processing. The difference between targets, goals, and quotas is how they're managed and that is where the abuse comes in.

Poor managers use statistics poorly, don't you know... No surprise there. And political masters tend to act in such a way as to shield their posteriors from the dull blunt instrument of the press.

There is a clear difference between targets and quotas selling trinkets and services versus targets for cutting people off of employment insurance. Can we agree on that? Encouraging sales persons to sell things is one thing, but encouraging people to deny EI claims is quite another.

Edited July 24, 2013 by cybercoma

[Bryan]

There is a clear difference between targets and quotas selling trinkets and services versus targets for cutting people off of employment insurance. Can we agree on that? Encouraging sales persons to sell things is one thing, but encouraging people to deny EI claims is quite another.

No. It's the same. People doing a specific job aiming to hit a specific performance level. Catching fraud is their job, and they have modest guidelines for how much fraud the employer would like them to try to find. If anything, those targets should be much higher.

[Michael Hardner]

There is a clear difference between targets and quotas selling trinkets and services versus targets for cutting people off of employment insurance. Can we agree on that? Encouraging sales persons to sell things is one thing, but encouraging people to deny EI claims is quite another.

Yes, we can agree on that.

"Encouraging people to deny EI claims" shouldn't happen, and it would only happen if targets weren't managed properly. "Encouraging staff to enforce the rules properly" would be the goal, and monitoring against targets would be one way to do that.

[cybercoma]

No. It's the same. People doing a specific job aiming to hit a specific performance level. Catching fraud is their job, and they have modest guidelines for how much fraud the employer would like them to try to find. If anything, those targets should be much higher.

No it most certainly is not the same. Setting targets for people to buy into EI, if it were optional, would be the same. Setting targets for the amount (in dollars) of claims that ought to be denied is something entirely different. I don't know how to make it any clearer for you.

Yes, we can agree on that.

"Encouraging people to deny EI claims" shouldn't happen, and it would only happen if targets weren't managed properly. "Encouraging staff to enforce the rules properly" would be the goal, and monitoring against targets would be one way to do that.

There's no indication that there's a problem with staff enforcing the rules. You're still taking this angle, but I haven't heard this argued anywhere. No one has come out and said that there needs to be targets because people aren't doing their jobs. What has been said is that the government wants to recoup money from EI because it costs too much, so they're encouraging the staff to meet targets. Those targets absolutely encourage them to cut people off because the targets are meant to reduce what's being paid out. The problem with this is that EI is not a universal benefit. It's a benefit for those who worked, particularly for a set number of weeks prior to losing their job, and paid into the program with their employers matching their contribution. Someone like my wife, for example, is self-employed and is actually required to pay double as employer and employee. This is the important part: that money is not part of the general tax revenue. However, the Tories are using it as general tax revenue and are treating the administration of these funds like it's part of the general tax revenue. In other words, they're misappropriating funds, which are meant to sit there unused until they're needed. Setting targets for cut-offs is completely unethical, since people are paying into this insurance and have a reasonable expectation to be covered when they need it. It's completely unethical for the government to encourage people working at EI to find savings by cutting people off and set a number on it as to how much they're required to find. Like I've been alluding to the entire thread, a reasonable person would leave their home or auto insurance company if they knew that the people in charge of the company were setting denial targets for their claims adjusters. This is quite different than setting sales targets for their sales force. Encouraging adjusters to deny claims by its very nature is going to make it far more difficult for you to collect, despite you paying into the service for an extended period of time. In short, the government management of the program is inappropriate and encourages the employees to make it far more difficult for people to make a claim when they have every right to do so, having paid into the program for so long. You want to see the government change their tune on this one, they should make it possible for employees to sue their employer when they lose their job should they be rejected for EI. Because that's one of the purposes of the program. You could no longer sue your employer for poor economic decisions that led to your dismissal. This is a benefit to them. If the employees can't receive their benefit from the program or the administration is setup in a way that encourages them to be denied their benefit from the program, then imagine if the administration was setup to encourage the denial of the business side's benefit. I say let people sue their employer for fiscal mismanagement, if the employee can't collect.

Edited July 25, 2013 by cybercoma

[Michael Hardner]

There's no indication that there's a problem with staff enforcing the rules. You're still taking this angle, but I haven't heard this argued anywhere.

If they don't measure it, then there's no way of knowing if there's a problem or not.

Frankly, given the way government usually reacts to problems (ie. waits until they're in the front page or discussed in Question Period) I'd prefer them to go this route.

No one has come out and said that there needs to be targets because people aren't doing their jobs. What has been said is that the government wants to recoup money from EI because it costs too much, so they're encouraging the staff to meet targets.

Part of the government's job should be to save money where possible. This is a reasonable way to do that.

Those targets absolutely encourage them to cut people off because the targets are meant to reduce what's being paid out.

Not necessarily. The goal can be to limit disbursements to what is permitted in th epolicy.

However, the Tories are using it as general tax revenue and are treating the administration of these funds like it's part of the general tax revenue.

This was a problem with the Liberals too. It goes both ways, and is especially worrying when they do this with pension funds, and even more so when private companies do that.

a reasonable person would leave their home or auto insurance company if they knew that the people in charge of the company were setting denial targets for their claims adjusters.

We don`t know whether or not this happens, though, with private companies. Well, at least not as easily as in the public sphere.

[Scotty]

Cops have accountability,

Nonsense. Cops quite literally get away with murder.

they work in pairs

Not usually in Canada.

or get calls from the dispatcher, or have to respond directly to somebody making a complaints. Fraud workers do not, they work individually pushing paper reviewing files. If they decide to ignore something, nobody else would ever be aware of it.

Oh? Really? So cops don't have discretion to write a ticket or give a warning? Cops don't have discretion when they see someone drunk to arrest them or send them home? Cops don't have discretion about whether to tazer a guy or try and talk to him for a few seconds? Don't give me that nonsense. Cops have tons of discretion.

Oh and btw....cops have.....gasp......quotas! I guess according to you, their work is now invalid.

It's the quotas that are invalid. Quotas means that in grey areas where an employee needs to have discretion so as to not come out as an overbearing scumbag their discretion is limited by the numbers they face. Quota means that harried single mom in the fourteen year old car late for her minimum wage job gets a ticket for barely exceeding the speed limit.

Edited July 26, 2013 by Scotty

[Scotty]

The EI targets are the same thing. Millions upon millions of dollars are being defrauded each year. That investigator was tasked with finding a fraction of that, but she balked at the idea of actually having to investigate. She didn't think she'd have to call people? Or actually leave the office once in a while? And she's got the nerve to not only complain, but to leak information she signed a confidentiality agreement on? Seriously, she should be fired.

I guess you chose not to even read the story. The quota had nothing to do with her doing her job. She was tasked to investigate claims and find improper claims. Note, not fraudulent claims, just claims where the documentation or times had issues. There would have been a lot of these cases where people made honest mistakes on their paperwork or in their statements. The quotas urged her and others like her to cut them off at the knees rather than showing any discretion.

[hitops]

Those quotas (...er ...targets) are driving proper police work. When a cop is told to go and write 50 speeding tickets, s/he is not supposed to write tickets to random people. Police departments know that hundreds (if not thousands) of people are speeding each day along that officer's route, all he has to do is be dilligent enough to catch 50 of them.

The EI targets are the same thing. Millions upon millions of dollars are being defrauded each year. That investigator was tasked with finding a fraction of that, but she balked at the idea of actually having to investigate. She didn't think she'd have to call people? Or actually leave the office once in a while? And she's got the nerve to not only complain, but to leak information she signed a confidentiality agreement on? Seriously, she should be fired.

Exactly. If government departments have no strong direction, there is absolutely no incentive to do anything.

There is a clear difference between targets and quotas selling trinkets and services versus targets for cutting people off of employment insurance. Can we agree on that? Encouraging sales persons to sell things is one thing, but encouraging people to deny EI claims is quite another.

No, in economic terms the concept is exactly the same. You are getting performance with some kind of targets. In emotional terms, yes they are different. But I the taxpayer, should not be forced to pay to assuage somebody's emotional discomfort. I want performance from my public officials.

I'm arguing that the logic behind quotas and targets is faulty and that it creates an environment where rejecting valid individual claims is encouraged to meet goals created from meta data.

No it is not. There is no logical reason that would be true nor is there a shred of evidence that it is happening. It is just as, if not more likely, that the targets are underestimating the amount of fraud. But if you don't make targets, you will never have any way to knowing because you cannot quantify how difficult it is to achieve the targets.

a reasonable person would leave their home or auto insurance company if they knew that the people in charge of the company were setting denial targets for their claims adjusters.

A reasonable person would opt out of paying tax money for wasteful government programs, if they had the choice. We do have that choice with a home or auto insurer, but not with the government. That's the difference, a difference I don't believe you appreciate. One is a choice, I choose to not go with x home insurance company if I think they are likely to deny my future claim. The other is coercion, the government forces me to pay no matter what.

Edited July 27, 2013 by hitops

[Argus]

Yes, we can agree on that.

"Encouraging people to deny EI claims" shouldn't happen, and it would only happen if targets weren't managed properly. "Encouraging staff to enforce the rules properly" would be the goal, and monitoring against targets would be one way to do that.

I have never been in a job with the federal government where any kind of proper time and motion analyses had ever been performed which would allow management to know just how much time needed to be spent on a given task. In most of the jobs I've worked the estimate of hours needed per task were either over or under reality by up to 500%. Basically, what you're expected to do is whatever the last person who had that job did. If they were brilliant and really fast, you're in trouble. If they were lazy and stupid you're going to be spending a lot of time twiddling your thumbs. So pardon me if I have no faith at all in whatever targets were set

[Argus]

Exactly. If government departments have no strong direction, there is absolutely no incentive to do anything.

Blather. You think anyone wants to sit around all day doing nothing? You have any idea how long that makes your day? A proper target would be something like how many case files to review in a given period. Statistically, not every batch of files is going to have the same number of improperly filled out paperwork. A quota on results rather than on work could easily require the employee to find reasons to cut people off in order to meet them.

[Argus]

We don`t know whether or not this happens, though, with private companies. Well, at least not as easily as in the public sphere.

Of course we do! We've seen lots of testimony before congress and the courts that insurance companies, at least in the US, have set quotas and rewards for cutting people off and refusing to pay their benefits. Doctors have testified of the rewards they get for finding excuses not to pay for health care, and the punishment for not cutting off enough people.

[cybercoma]

A proper target would be something like how many case files to review in a given period.

This I agree with.

[Argus]

My sister once worked at assessing tax claims. Their group only had a month or so of training, and there was a lot of uncertainty what they were doing. Management only cared about one thing: get them out the door! Push them through! Don't worry, just do it! Whenever they fell behind management would have a 'no questions day' wherein employees were told not to ask questions about whether a claim was good or not, just deny it and send it out. When conscientious employees held back files they really weren't sure of to ask on another day, management got angry. You see, even if the decision was wrong, and was appealed (they usually aren't), the file would go to a different group anyway.

And as bad as management is at CRA, the people I talk to at Service Canada say it's worse there.

[Michael Hardner]

So pardon me if I have no faith at all in whatever targets were set

I have to give the benefit of the [extreme] doubt.

[Michael Hardner]

Of course we do! We've seen lots of testimony before congress and the courts that insurance companies, at least in the US, have set quotas and rewards for cutting people off and refusing to pay their benefits. Doctors have testified of the rewards they get for finding excuses not to pay for health care, and the punishment for not cutting off enough people.

If you say so. It's not as easily ascertainable, though, in terms of how frequent this happens.

So, I guess you're disagreeing with Cyber's comment above in the end.

[Michael Hardner]

This I agree with.

Ok, but it's just another metric in the end.

[cybercoma]

Ok, but it's just another metric in the end.

That's why I made that point because it's not metrics in general that I disagree with. It's bad metrics that are a problem.