Finding 391157 (2023-001)

Program Name/ALN Title: Health Center Cluster Federal Assistance Listing Number: 93.224/93.527 Federal Agency: U.S Department of Health and Human Services Award Period: 7/1/2022 – 06/31/2023 Federal Award Number: N/A Type of Finding: Significant Deficiency Criteria: Under the compliance requirement for Special Tests and Provisions for ALN 93.224/93.527, “health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay”. In one identified instance, an incorrect sliding fee discount was applied, resulting in the patient being overcharged for services provided. Condition: CLA identified one instance of the key control not being met while performing testing over the special tests and provisions compliance requirements. Context: CLA identified one instance out of 25 total tested of which the key control was not being met while performing testing over the special tests and provisions compliance requirement. Cause: The sliding fee application effective for the transaction tested indicated the patient qualified for a Level B sliding fee discount. However, upon recalculation the patient should have been noted as Level A sliding fee discount. Effect: Incorrect sliding fee discount was applied to the transaction tested resulting in the patient being overcharged for services. Recommendation: We recommend that Aviva Health implement a process to internally audit the new applications on a monthly or quarterly basis. Views of the Responsible Officials: There is no disagreement with the audit finding. Corrective Action Plan: Aviva health has scheduled a mandatory training to refresh all staff that evaluate and approve sliding fee. the organization has and continues to follow their policy and procedure for review of sliding fee determination prior to adjustment.