Nonprofit hospital systems like Roanoke, VA-based Carilion have seen their power over their regional communities increase as their incomes have surged. Critics say, however, that this is creating untaxed local healthcare monopolies that drive the costs of care higher. Nonprofits have also come under fire from patient advocates and members of Congress for stinting on charity care even as they amass large cash hoards, build new facilities, and award big paychecks to their executives.