Thousands of doctors across the country are billing Medicare for routine medical care at rates far above their peers, potentially costing taxpayers tens of millions of dollars in overcharges, according to a new government report.

The audit released today by the U.S. Department of Health and Human Services Office of Inspector General stopped short of accusing the high-billing doctors of ripping off the government health plan for the elderly. But it stated that Medicare’s payment scales for doctors have been “vulnerable to fraud and abuse” in recent years.

The doctor payment scales are known as “Evaluation and Management” or E/M codes. Doctors choose from five escalating payment levels for treating patients based on the “amount of skill, effort, time responsibility and medical knowledge required for the service.” In 2010, almost 370 million E/M services were provided by about 442,000 doctors nationwide.

The code the doctor chooses can make a big difference to the bottom line. For instance, the Medicare fee for treating a new patient in 2010 ranged from $36.62 to $190.56, depending on the level of service provided by the doctor, and the code chosen for billing.

Using these codes, Medicare paid doctors and other health professionals $33.5 billion in 2010 for services ranging from routine office care to hospital or nursing homes visits.

That billing total represented a 48 percent jump since 2001, though the number of services delivered over the same time period grew only 13 percent. What the data reveal is that many doctors have been gravitating toward the codes that pay them higher fees for these routine services, a practice officials have struggled to understand and curb.

Forget one-size-fits-all advice: Guidelines out yesterday give women choices for cervical cancer testing that depend on their age.

Once recommended every year, many major medical groups have long said that a Pap test every three years is the best way to screen most women, starting at age 21 and ending at 65.

But starting at age 30, you could choose to be tested for the cancer-causing HPV virus along with your Pap — and get checked every five years instead, say separate guidelines issued by the U.S. Preventive Services Task Force, the American Cancer Society and some other organizations.

It's not a requirement — women 30 and over could stick with the every-three-years Pap and do fine, the guidelines say.

Women over 65 can end screening if they have had several negative tests in a row over a certain time period. But women in that age group who have a history of pre-cancer should continue routine screening for at least 20 years.

The question is whether doctors will follow the recommendations. Last year, an iWatch News investigation found 40 percent of Medicare-funded cancer screenings to be unnecessary, especially for the elderly. Though the Preventive Services Task Force is widely-regarded as an industry expert for screening recommendations, the guidelines are often ignored. Already, studies have shown that too many doctors are giving younger women routine HPV tests, contrary to long-standing advice. Even patients have wondered if it's really OK not to get a yearly screening.

The Obama Administration is disputing claims by two Republican senators that Michael Jackson’s physician mistakenly remained eligible to bill Medicare long after being convicted for his role in the singer’s 2009 death. But the lawmakers aren’t backing down.

Sens. Orrin Hatch, R-Utah, and Tom Coburn, R-Oklahoma, on Tuesday sent a letter to Medicare’s administrator alleging that Jackson’s doctor, Conrad Murray,  and at least 34 other convicted felons and unlicensed physicians remain listed as legitimate physicians on the health plan’s provider database. Murray was convicted of involuntary manslaughter in November, which the Senators said should have caused him to be immediately kicked out of the program.

Centers for Medicare and Medicaid spokesman Brian Cook said the senators are mistaken. Conrad’s “enrollments have been revoked and deactivated, and the latest that he billed Medicare was in 2010,” Cook said. The spokesman declined to comment further about the other doctors the senators mentioned in the letter, or to shed light on the precise day when Murray was pushed out of the program.

So far, the senators are not buying the CMS explanation.

Michael Jackson’s private physician, Dr. Conrad Murray, was sentenced to four years in jail Tuesday for his role in the singer’s 2009 death, but so far he hasn’t been pushed out of the Medicare program.

According to a letter two senior Republicans on the Senate Finance Committee sent to Medicare’s administrator on Tuesday, Murray and other convicted felons and unlicensed physicians are still listed as legitimate physicians on the health plan’s provider database, pointing to a serious vulnerability that leaves the program open to fraud and could put seniors at risk.

Conrad’s case “illustrates Medicare’s failure to act in the best interest of seniors,” wrote Sens. Orrin Hatch, R-Utah, and Tom Coburn, R-Okla, in the letter to Health and Human Services Secretary Kathleen Sebelius. A spokesman for the Centers for Medicare and Medicaid Services had no immediate comment.

Murray’s case is a high profile example of Medicare’s failure to remove convicted felons and doctors who have lost their medical licenses from the program, an issue highlighted earlier this year by iWatch News. In Murray’s case, California suspended his medical license in January. In November, Murray was convicted of involuntary manslaughter. Yet Murray is still listed as a Medicare provider in the CMS internal database. “Despite the national media coverage of Dr. Murray’s conviction, he remains a legitimate Medicare provider,” Hatch and Coburn wrote in the letter.

Surgeries performed on the wrong body part, instances of sexual assault and incorrect blood transfusions—these are just a sampling of the adverse events that more than a quarter of Medicare beneficiaries experienced while they were in treatment at hospitals, according to a month-long survey conducted as part of a recent Department of Health and Human Services inspector general’s report.

The Oct. 2008 survey of 81 hospitals found that 27 percent of Medicare beneficiaries experienced adverse events — medical errors or other improper treatment that result in patient harm — while in hospitals. But reduction of such adverse events has been hampered, the report says, by a complex and confused hospital oversight structure. The report, Adverse Events in Hospitals: National Incidence Among Medicare Recipients, was released last week.

Hospitals bear the primary responsibility for investigating adverse events, but who dictates how outside investigations should proceed is less clear. Hospitals that participate in the Medicare program must either be accredited by the independent, nationally recognized Joint Commission or demonstrate to the Centers for Medicare & Medicaid Services (CMS) that they are in compliance with a list of 23 Medicare conditions of participation, called CoPs.

Outside the scope of a hospital’s governing body, state agencies are responsible for investigating adverse events at hospitals. However, if the hospital is accredited by the Joint Commission, that state agency must report adverse events to CMS’s regional office and receive feedback from that office before beginning an investigation or making any recommendations. Even though 90 percent of hospitals elect to be accredited through the Joint Commission, CMS regional offices often failed to notify the commission of complaints, impeding the Commission’s oversight of its hospitals.

A government panel’s controversial recommendation that healthy men should no longer be routinely screened for prostate cancer is fueling a continuing debate over unnecessary Medicare spending for cancer screening — the subject of a recent iWatch News investigation.

Last week, draft guidelines of the U.S. Preventive Services Task Force advised men against routine prostate cancer screening using the prostate-specific antigen (PSA) test because the test often leads to more harm than good, with the potential for harm posed by aggressive treatment offsetting any gain.

The findings were strongly disputed by the American Urological Association, which called the task force recommendations a disservice to men. The urologists say the test saves lives and provides important information to men about their health. On Friday, however, the Annals of Internal Medicine published an outside panel’s review of evidence backing the task force recommendations.

Terry Waddell knew that her 87-year-old mother did not have long to live. The woman’s organs were shutting down because of old age, she said, and her arthritic body had withered to 80 pounds.

So, when Waddell received a call about her mother’s health, it was not what she expected. A visiting nurse had noticed a bit of blood between the frail woman’s legs and wanted her screened for cervical cancer.

Waddell, of Houston, regrets that she took her mother for the test. She refused to let doctor’s aides weigh her, she said, protesting that getting her mother out of her wheelchair was too arduous a process. Then came the actual exam, which she said “was painful to watch.” Her mother struggled to open her legs wide enough for the procedure and then lay there, quietly crying.

“I blame myself for not stopping this,” said Waddell, whose mother died two months later.“It was totally unnecessary.” Unnecessary, perhaps, but surprisingly common.

Cancer screening tests are vastly overused in the United States, with about 40 percent of Medicare spending on common preventive screenings regarded as medically unnecessary, an iWatch News investigation reveals. Millions of Americans get such tests more frequently than medically recommended or at times when they cannot gain any proven medical benefit, extracting an enormous financial toll on the nation’s health care system. Doctors disregard scientific guidelines out of ignorance, fear of malpractice suits or for financial gain, as patients inundated by medical advertising clamor for extra tests.

In the frenzied hunt for cancer, the risks of the screenings also get overlooked. Besides producing anxiety, screening people for cancer can itself cause injuries — even death — or set off a cascade of expensive tests and treatments that can waste more money and create more problems.