Medicare Compliance Review of Boca Raton Regional Hospital, Inc., for 2011 and 2012

Boca Raton Regional Hospital, Inc. (the Hospital), located in Florida, complied with Medicare billing requirements for 161 of the 211 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 50 claims, resulting in overpayments of $514,000 for the audit period. The outpatient claims selected for review did not contain errors. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors. On the basis of our sample results, we estimated that the Hospital received at least $2.6 million in overpayments from Medicare.