U.S. Senator Claire McCaskill, D-Missouri, wants answers from Colorado-based Envision Healthcare and its subsidiary EmCare Holdings, Inc. about reports of sharp increases in EmCare emergency room costs. According to those reports, EmCare tripled the highest rate for ER visits at one hospital that was studied and allegedly pressured ER doctors to order expensive, unnecessary tests for patients.

Senator Claire McCaskill (D-Missouri)

EmCare manages more than ten hospitals in Missouri.

“Emergency room visits can be far too expensive already—and if EmCare is gaming the system just to up their profits, that needs to be thoroughly investigated,” McCaskill says. “I’m committed to protecting patients in Missouri and across the country by getting to the bottom of what’s going on with EmCare’s billing.”

In a letter to Envision President and CEO Christopher A. Holden, McCaskill details her concerns with EmCare’s reported practices, writing that “EmCare staffing and management have led to a decline in health care quality and access for patients in communities around the country.”

One study that looked at 16 hospitals found that out-of-network billing rates increased by more than 70%—rates that were often passed onto patients. Another report found that similar services at a hospital rose from $467 to $1,649 when EmCare took over the hospital’s staffing and billing.

“These [rising] costs have a significant adverse impact on the communities where EmCare operates and on the unsuspecting patients,” McCaskill continues.

She has requested information from Envision about any bonuses physicians receive for lab testing rates, how much Envision or EmCare has received from the federal government, and their percentage of out-of-network billing.