Evergreen Treatment Services: Rebilling Medicare Opioid Treatment Bundles That Were Already Paid

In the Evergreen Treatment Services fraud case, the Seattle nonprofit agreed to pay $1,453,982 to settle allegations that it knowingly billed Medicare again for opioid treatment services already paid through weekly bundles. A treatment record tells one part of that story. The billing and payment history tells the rest.

The Justice Department announced the settlement on June 13, 2024, on behalf of the Department of Health and Human Services.

What Medicare Had Already Paid For

Medicare paid Evergreen for weekly opioid treatment bundles covering medications, counseling, therapy and toxicology testing. Intake activities and periodic assessments have separate add-on payments under Medicare’s opioid treatment program benefit.

Medicare’s opioid treatment program benefit began on January 1, 2020. The Centers for Medicare & Medicaid Services’ billing guidance describes a weekly episode covering seven consecutive days, with at least one covered drug or nondrug service needed to qualify. The payment unit is a treatment week, while the clinical work within it can involve different services and different staff.

That is why the bundle matters to a billing employee, counselor or laboratory coordinator. A service has both a clinical identity and a place in the payment arrangement. Counseling or testing can appear in its own treatment record while the payment for that work sits inside a weekly bundle. Connecting those records is how we identify what the government already bought.

Earlier Treatment, Later Resubmissions

The government alleged that Evergreen resubmitted bills for services Medicare had already paid. The original claims covered January 1 through July 2020, and Evergreen submitted them during that year. Medicare paid those claims.

The Justice Department alleged that Evergreen then knowingly submitted the paid bills again from January 8 through February 26, 2021. The government alleged that Medicare reimbursed Evergreen again for those services. These were later billing dates attached to earlier paid care.

We see a straightforward wrong in that allegation. Taxpayers had already paid for the treatment. The second bill bought them nothing new.

The Settlement Paired Repayment With a Civil Penalty

The settlement required Evergreen to repay $726,991, the amount the government identified as the duplicate billings, and pay an equal penalty under the False Claims Act.

The money at issue was meant to fund drug treatment. In a program that pays for medication, counseling and testing together, a second payment for old care takes money from the same public program patients depend on.

What Agency Investigates Healthcare Fraud?

The Department of Health and Human Services Office of Inspector General and the U.S. Attorney’s Office identified Evergreen’s alleged double billing through data analysis. The Justice Department credited the office’s Affirmative Civil Enforcement unit with that work. The Justice Department also credited the inspector general and the Drug Enforcement Administration’s Diversion Control Division with significant investigative assistance.

The government identified the problem by examining billing data. The operational story was in the relationship between requests for payment and payments already made.

Counseling and Testing Can Be Charged Twice

In the Medicaid cases involving APT Foundation, New Era Rehabilitation Center and Connecticut Counseling Centers, the government alleged separate charges for counseling or testing already covered by a weekly methadone bundle. The Evergreen allegation focused on resubmitting bills already paid.

Medicare’s Review Found Overlapping Treatment Payments

The inspector general’s 2023 review of Medicare opioid treatment payments identified potentially improper payments involving overlapping bundles, overlapping take-home medication, missing opioid use disorder diagnoses and repeated intake activity. It examined claims and payment controls without reviewing medical records.

Those findings bring the same operational questions into view: which treatment interval a claim covers, what service it represents and whether that service has already been paid. They also show why a person who understands the treatment program can add meaning to a pattern in billing data.

What Evidence Is Needed to Prove Fraud?

Treatment records, claims and payment histories connect the care to the money already paid for it. Our whistleblower experts work with you to make those connections in a suspected duplicate-billing case.

The Evergreen chronology makes those connections concrete. We examine how the original paid claim relates to the later submission.

The person who understands that connection can give the numbers context. You may know which services the weekly payment covered or how the claims were submitted. We work with that knowledge to develop the case around the paid services and the decisions behind the additional claims.

How Much of a Settlement Does a Whistleblower Get?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know What Was Already Paid

If you worked with treatment records, weekly bundles or repeat claims, tell our whistleblower experts where the second bill came from. We connect your view inside the program to the payment history, build the case with you and bring in health care fraud whistleblower lawyers who know opioid-treatment reimbursement. You have partners from that first conversation through the pursuit of a recovery.