A group of U.S. senators and representatives penned a letter to the COVID-19 Response Team and other agencies on Wednesday, urging them to investigate allegations of overpricing by nurse staffing agencies relied on to fill gaps in hospital staffing during the pandemic.

In the letter, Sens. Mark Kelly (D-Ariz.) and Bill Cassidy, MD (R-La.), and Reps. Doris Matsui (D-Calif.) and David B. McKinley (R-W.Va.) wrote, “We have received anecdotal reports that the nurse staffing agencies are vastly inflating price, by two, three or more times pre-pandemic rates, and then taking 40% or more of the amount being charged to the hospitals for themselves in profits.”

They asked for an investigation by “one or more of the federal agencies with competition and consumer protection authority” to find any evidence of anti-competitive price patterns, price collusion, higher pay for nurses as a result of the rate increases, and impact on rural and underserved areas, among other questions.

The Congress members could not be reached for comment in time for publication; nor did the American Hospital Association, which posted the letter in the “advocacy” section of their website, respond to a request for comment.

While the letter did not name any specific staffing agencies, Kelly Rakowski, chief operating officer for strategic talent solutions at AMN Healthcare, which says it’s the nation’s largest healthcare staffing agency, wrote in an email to MedPage Today in a general response that its “pricing is agreed upon directly with our healthcare organization clients. Inflationary pressures and demand are driving up the wages needed to attract clinicians to open positions. Any price increases are driven primarily by the compensation that goes directly to healthcare practitioners.”

A number of factors have exacerbated a climate in which nurses are badly needed. The national pandemic not only increased directly to the number of patients needing care, but also drove some nurses out of the healthcare system as they faced burnout and even abuse. Nurses, in some cases, left staff jobs for higher paying travel-nursing contracts brokered by nurse staffing agencies.

According to the Bureau of Labor Statistics, the seasonally adjusted number of nursing and residential care facility staff on payrolls nationwide dropped by 157,000 from October 2020 to October 2021, to just under 3 million, although the end of that period saw slight increases. National data, however, doesn’t reflect the need for nurses in particular geographic areas where the need is greater, for example, as COVID-19 hotspots shift.

On top of the strain from COVID-19 itself, hospitals and healthcare systems implementing vaccine requirements have dealt with nurses and other healthcare workers — albeit, a seemingly small percentage — refusing vaccination and leaving or being fired because of it.

The letter follows complaints from a number of state healthcare associations, including in Pennsylvania and Delaware, regarding rate increases. The heightened costs for nurses have, they say, rendered hospitals unable to compete with staffing agency pay rates, and thus made them unable to retain local nursing staff.

In a letter to Delaware legislators that echoes the one sent by the members of Congress, the president and CEO of the Delaware Healthcare Association wrote: “The ability to safely continue the high quality of care patients have always received in Delaware hospitals rests on an adequate supply of local nurses and staff. This adequacy of supply is under assault by nurse staffing agencies.”

In Oklahoma, one hospital refused to pay staffing agencies what they were asking, reported the Southwest Ledger, although the Oklahoma Hospital Association said the price increases were likely just a result of increased competition. “I hadn’t heard anything about price-gouging,” a representative for that hospital association told the Southwest Ledger.

In Massachusetts (one of the only states to set limits on what staffing agencies can charge hospitals to supply their staff), a hospital chain and a staffing agency, both based outside of Massachusetts, sued one another over staffing in April, the Wall Street Journal reported. The agency, Aya Healthcare, says the hospital, Steward Health Care Systems, owes them $40 million for staff — and that they can’t pay their bills without the money. Steward said the agency’s rates were illegally inflated and asked a judge to keep the agency from pulling staff from its hospitals.