$45M Botox Medicare fraud; teen drug use stays near historic lows; women may recover slower from stroke – Morning Medical Update

Physician indicted in $45M Botox Medicare fraud

A California physician has been indicted for allegedly orchestrating a massive Medicare fraud scheme involving Botox injections that were medically unnecessary or never provided. Federal prosecutors say Violetta Mailyan, M.D., 45, of Los Angeles County billed more than $45 million through her practice, Healthy Way Medical Center, for injections purportedly given on dates when she or her patients were traveling internationally, when a beneficiary was incarcerated, or when the clinic was closed. The superseding indictment charges Mailyan with nine counts of wire fraud and three counts of obstruction of a criminal health care investigation, alleging she also submitted falsified medical records in response to a grand jury subpoena.

If convicted, she faces up to 20 years in prison on each wire fraud count and up to five years on each obstruction count. Federal officials emphasized that the indictment is an allegation and that Mailyan is presumed innocent unless proven guilty.

Teen drug use stays near historic lows

Use of most substances among U.S. teenagers remained low in 2025, holding near the historic lows first seen during the COVID-19 pandemic, according to the latest Monitoring the Future survey supported by the National Institutes of Health (NIH). The annual survey of eighth, 10th and 12th graders found that abstention from alcohol, marijuana and nicotine remains high, with 91% of eighth graders, 82% of 10th graders and 66% of 12th graders reporting no use in the past 30 days.

Alcohol, cannabis, vaping and nicotine pouch use were largely unchanged from 2024. Researchers did note small but statistically significant increases in reported heroin and cocaine use, though overall prevalence remains well below levels seen decades ago.

Women show slightly poorer recovery after stroke

Female patients may face greater challenges regaining independence after an ischemic stroke, according to a new study published in Neurology. Researchers followed more than 1,000 people after their first ischemic stroke and found that women had more difficulty than men performing daily activities such as eating, dressing, cooking and driving at three, six and 12 months post-stroke.

The differences persisted even after adjusting for age, education, race and ethnicity, and insurance status, though the effect size was small. Neurological recovery improved similarly in both sexes, suggesting the gap is more pronounced in functional daily tasks. The authors say early and repeated assessments of daily living abilities — particularly for female patients — and targeted interventions such as muscle-strengthening activities could help narrow these recovery differences.