Efforts to reduce unnecessary ER visits by patients in Medicaid, the joint state-federal health program for the poor and disabled, are proliferating as states search for ways to control the soaring costs of the program. But state officials complain that their efforts are sometimes hampered by hospitals' aggressive marketing of ERs to increase admissions and profits. "Many hospitals are actively recruiting people to come to the ER for non-emergency reasons," said Anthony Keck, South Carolina's Medicaid director, citing facilities that tout their speedy ER service on highway billboards. "When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims," he said. HCA, the nation's largest for-profit hospital chain, launched a major ER marketing campaign in the past year in Virginia, Florida, Texas and other states. The campaign includes billboards highlighting average ER waiting times and a service that provides waiting times to smartphone users. Officials at HCA and other hospitals reject the assertion that marketing the efficiency of their ERs attracts patients who don't belong there. "That is certainly not our intention," said Mark Foust, a spokesman for HCA's Virginia division. "We've seen no evidence that this is driving inappropriate volume to the ER."