Envision Healthcare's CEO abruptly stepped down Thursday as the private-equity owned physician services provider navigates a congressional investigation into its billing practices.
The Nashville-based company didn't give a reason for Chris Holden's departure, but it comes as federal lawmakers review Envision's responses to their December inquiry into its billing practices. It also follows revelations that Envision's owner, private equity firm KKR, poured millions of dollars into a dark money campaign to thwart surprise billing proposals that would harm Envision's bottom line.
"To the extent that balance billing is a part of any one company's billing practices, that has raised red flags for policymakers at federal and state levels," said Kevin Lucia, a research professor in Georgetown University's Center on Health Insurance Reforms.
Envision, which has been owned by KKR since October 2018, said it's conducting a national search for Holden's replacement. In the meantime, Chief Operating Officer Karey Witty, Chief Financial Officer Teresa Sparks and Chief Administrative Officer Dave Esler will lead the company.
"On behalf of the board of directors, we appreciate Chris' dedication to Envision's clinicians and employees and thank him for his many contributions to the company," Max Lin, KKR partner and Envision director, said in a statement. "Envision is a special organization with exceptional people playing a vital role in the U.S. healthcare system today."
Amid numerous reports of patients being hit with unexpected medical bills from out-of-network physicians following hospital visits and research that has targeted Envision as a main culprit, members of the U.S. House Energy and Commerce Committee and U.S. Senate Health, Education, Labor and Pensions Committee sent a letter to Holden on Dec. 19 that contained more than a dozen questions about Envision's business practices.
"Evidence indicates that these physician staffing firms charge significantly higher in-network rates than their counterparts, thereby driving reimbursement upwards as they enter into staffing arrangements with hospitals," the letter said. "In recent years, some physician staffing companies have been acquired by private equity firms."
KKR acquired Envision in 2018 a deal valued at $9.9 billion in cash and assumed debt. Two years earlier, affiliates of the private equity firm Blackstone Group bought another physician staffing giant, TeamHealth.
In the letter to Holden, lawmakers asked what role KKR plays in Envision's strategy, management and operations. More specifically, they asked if KKR officials had advised Envision on whether to go in-network with insurers.
The letter also requested the profit and revenue Envision earned from out-of-network billing to commercial insurers both before and after its purchase by KKR.
C.J. Young, a spokesman for the House Energy and Commerce Committee, confirmed the committee did receive a response from Envision by its Jan. 9 deadline, but declined to share the response, saying the committee was still reviewing it.
Aliese Polk, a spokeswoman for Envision, declined to comment on the Congressional investigation. KKR, which received a similar letter from Congressional leaders, declined to comment.
Polk wrote in an email that since acquiring Envision, KKR has supported the company's work to be in-network with insurers.