Performance bonuses were paid to Department of Veterans' Affairs doctors who were disciplined for practicing with an expired license, refusing to see emergency room patients, and leaving the operating room during surgery, according to a report issued Friday.

Every medical professional eligible for extra pay got it, regardless of performance or discipline, at the four hospitals studied by the Government Accountability Office.

The VA has no clear policy on what constitutes exceptional performance that should be rewarded by financial incentives, GAO found.

In the 2011 fiscal year, about 80 percent of the 22,500 doctors and dentists who work for the Veterans' Health Administration received performance pay boosts, which are annual awards in addition to their base salary, at a cost of about $150 million.

In addition, about 20 percent of those medical professionals received performance bonus awards that cost more than $10 million.

Not all VA medical professionals are eligible for performance incentives. Performance pay is supposed to be tied to meeting specific goals, while the bonus awards are supposed to be for exceptional work. However, GAO found even doctors with serious breaches of medical standards got the extra money.

For instance, one surgeon who was supervising residents left the medical center during an operation, leaving it to the residents to continue the procedure. They were unsupervised until another surgeon was found to oversee the operation.

The departing doctor was suspended without pay for 14 days, but received $11,189 in performance pay.

Another physician continued to practice medicine for three months at a VA facility on an expired medical license. The doctor was reprimanded when administrators found out, but still took home $7,663 in performance pay.

The reason: maintaining medical licenses was not listed as a performance goal in the physician's plan, therefore was not a factor that was considered in awarding the bonus.

"This is irrefutable proof of what we've known for quite some time: that in many cases, VA's performance pay and bonus system has absolutely nothing to do with performance," said Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans' Affairs.

Miller called on VA Secretary Eric Shinseki to conduct a review of the agency's standards for awarding bonuses. In May, Miller sponsored a bill that would put a five-year moratorium on VA bonuses.

At that time, he cited the large bonuses paid to agency officials amid a growing backlog of disability claims and preventable patient deaths at VA hospitals. VA cancelled payment of 2012 bonuses to officials at the Veterans' Benefits Administration, which handles disability claims, but not VHA.

Bonuses paid to top VA health officials are under intense scrutiny in part because of the large payouts to top officials at the VA Pittsburgh Healthcare System, where an outbreak of Legionnaires Disease in 2011 has been linked to at least five patient deaths and the sickening of as many as 21 others.

Terry Gerigk Wolf, director and CEO of the Pittsburgh VA system, received almost $13,000 in performance bonuses in 2011. Michael Moreland, the area's regional VA director, received more than $15,600 that year.

The Pittsburgh hospitals were not among those reviewed by GAO.

But GAO had no trouble documenting instances in which poor performance was rewarded at the four hospitals it studied in Atlanta, Dallas, Seattle, and Togus, Maine. Examples include:

• An emergency room doctor who refused to see patients after concluding they were not being properly triaged. As a result, some patients were forced to wait more than six hours, and nine left without being seen. The doctor was reprimanded, but still got a $7,500 performance pay bonus. The reason cited by hospital officials was that the emergency room as a whole met its performance goals, which accounted for 50 percent of the rating of the individual doctor. That was the only one of the 13 performance goals the doctor met.

• A doctor who could not be reached when he was required to be available, and had outbursts that involved yelling at staff with patients present. The doctor was suspended for three days, but still got a $10,529 bonus.

• A radiologist whose privileges were reduced for failing to read mammograms and other complex imagery correctly, who received $8,216 in performance pay.

None of the doctors is identified in the GAO report.

A VA spokeswoman, who refused to be quoted by name, said the agency agrees with GAO's conclusion that "more can be done to strengthen monitoring requirements and processes."

"VA remains committed to effective oversight to ensure that performance pay and award systems are based on the achievement of clear goals and objectives that contribute to VA's mission to serve Veterans," she said in a written statement.

VA officials told GAO they created a task force in May to develop guidelines on awarding performance pay.