U.S. Sen. Claire McCaskill is investigating potential overcharging of patients by a company that staffs emergency rooms across the country, including several in the Kansas City area.
McCaskill, a Democrat from Missouri, sent a letter last week to Christopher Holden, the CEO of Envision Healthcare. It requests information about the billing practices of an Envision subsidiary, EmCare, including whether EmCare gave physicians bonuses for ordering more lab tests or imaging tests like MRIs.
“Public reports indicate that as EmCare has expanded its work, costs to consumers have increased significantly without corresponding increases in the quality of care,” McCaskill wrote.
The Star left messages seeking comment from Holden and Envision Healthcare.
“We are not offering interviews at this time,” Kim Warth, Envision’s national director of communications, said via email.
McCaskill’s letter asks Holden to respond by Oct. 11.
EmCare contracts with dozens of hospitals across the country to provide physicians to staff their emergency departments. In the Kansas City area, its clients include Liberty Hospital and hospitals in the HCA Midwest Health chain like Research Medical Center, Overland Park Regional Medical Center and Menorah Medical Center.
McCaskill’s letter draws heavily on a Yale University study released in July that found that as hospitals outsource their emergency departments, patients are increasingly getting surprised by large bills for physician services that aren’t in their insurance networks, even if the hospital itself is in network.
The study’s authors said that EmCare and other contractors have an incentive to stay out of network and charge higher rates rather than negotiate with insurance companies because patients can’t choose to leave for another hospital in an emergency, even if they find out the physician is out of network.
EmCare is also a defendant in a federal whistleblower lawsuit that alleges the company pressured doctors to order tests that weren’t medically necessary and fired some that refused.
McCaskill’s letter says that EmCare’s emergency room services in Missouri have “been subject to several complaints about cost and care.” It cites Centerpoint Medical Center, an HCA Midwest hospital in Independence, for having a D- rating from the Better Business Bureau “for failing to respond to several complaints regarding billing.”
The BBB webpage shows five complaints related to billing or collections at Centerpoint in the last three years. But details were provided for only two of them and neither said the bills were related to emergency services. One was for a colonoscopy.
A spokeswoman for HCA Midwest released a statement saying Centerpoint and the rest of the HCA Midwest chain prides itself on being part of nearly every major health insurer’s network.
“We are sensitive to bills that patients may receive from affiliated or contracted physicians, and we encourage those physicians to participate in the same insurance networks as we do,” the statement said.
McCaskill sent the letter to Holden as the top Democrat on the U.S. Senate Homeland Security and Governmental Affairs Committee. She used her position earlier in the year to send letters to the leaders of five top opioid manufacturers requesting information about their marketing practices.