The private organization that clears hospitals to receive Medicare payments missed most problems later identified by state inspectors, potentially compromising patient safety, congressional investigators said Tuesday.

The Joint Commission on Accreditation of Healthcare Organizations (search), made up mainly of health professionals, failed to find 167 of 241 "serious deficiencies" in a survey of 500 hospitals that were reviewed between 2000 and 2002, the Government Accountability Office (search) said. The agency, Congress' investigative arm, was formerly called the General Accounting Office.

Many of the overlooked problems related to fire safety, while others involved substandard care. In a Texas hospital, a patient died after receiving a double dose of narcotics in the emergency room and "medications were administered without physician orders," the report said.

A California hospital lacked "a sanitary environment to avoid sources and transmission of infections and communicable diseases and failed to develop a system for ensuring the sterilization of medical instruments," the GAO said.

Hospitals approved by the commission are considered automatically eligible for participation in Medicare. It holds a unique status among accrediting agencies in that the federal Centers for Medicare and Medicaid Services (search) has no authority to force the commission to change its accreditation program.

The commission accredited 82 percent of U.S. hospitals in 2002, the GAO said. Those hospitals received $98 billion for Medicare-covered services that year.

Sen. Charles Grassley, R-Iowa, and Rep. Pete Stark, D-Calif., who jointly requested the report, are introducing legislation to increase Medicare's authority over the commission.

"While more may need to be done, the legislation we're introducing today will improve accountability by establishing a clear chain of command within the hospital oversight process," Stark said. "It will help assure that taxpayer dollars are being spent in facilities that meet Medicare's standards."

Commission president Dennis O'Leary said his group made sweeping changes to the accreditation process earlier this year. "In our view, it is irresponsible to alarm the public using statistics that have little meaning," O'Leary said in response to the GAO report.

Twenty-two of the 28 people on the commission's board represent hospitals, doctors and other health professionals.

Medicare chief Mark McClellan (search) said his agency agreed with the GAO report, but noted that no problems were found in most hospitals that were reviewed.