Medicare Advantage has grown to insure over half of all Medicare beneficiaries, but with that explosive growth has come an explosion in fraud. Billions of dollars in taxpayer money are being siphoned off through schemes that exploit the program's risk-adjustment payment system—from upcoding patient diagnoses to fabricating medical conditions entirely. In today's episode, we sit down with Eva Gunasekera from Tycko Zavareei to break down how Medicare Advantage actually works, how it differs from traditional fee-for-service Medicare, and why the government chose to effectively privatize the nation's largest insurance program. We explore the various fraud schemes plaguing the system, who the typical defendants are, and the unique challenges prosecutors and whistleblowers face when calculating damages in these cases. Eva Gunasekera is a whistleblower attorney at Tycko Zavareei specializing in healthcare fraud cases. Learn more about Eva here: https://www.tzlegal.com/people/eva-gunasekera/ Fraud in America is made possible by the generous donation of Getnick Law, a boutique Manhattan law firm dedicated to fighting fraud and promoting business integrity. ------------------ Fraud in America Social Links 🌐 Website - https://www.taf.org 👔 LinkedIn - https://www.linkedin.com/company/tafcoalition 🐦 Twitter - https://twitter.com/TAFCoalition ------------------ To learn more about Fraud in America, visit https://www.taf.org/podcast Thoughts? Guest suggestions? Email us at
[email protected]. "Fraud in America" is produced by Jacklyn DeMar and Grace Swindler. Our website was designed by Wide Eye Creative. Our music was made by Spatial Relations. Our visual assets were designed by PPA Agency. Fraud in America is a project of The Anti-Fraud Coalition a 501(c)(3) organization. You can learn more about it at https://www.taf.org.
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