$522M genetic testing fraud scheme targets Medicare and Medicaid; Trump drug pricing deal projected to save $64.3B over 10 years; the future of GLP-1 drugs – Morning Medical Update

Georgia men sentenced in $522M genetic testing fraud scheme targeting Medicare and Medicaid

Eleven co-conspirators were previously charged in connection with the same scheme.

Two Georgia men have been sentenced to prison for their roles in a scheme that submitted more than $522 million in fraudulent claims for medically unnecessary genetic tests obtained through illegal kickbacks, with Medicare, Medicaid and private insurers paying out approximately $84 million before the scheme was uncovered.

Reyad Salahaldeen, 57, who controlled four laboratories across New Jersey, Georgia and Texas, was sentenced to 151 months in prison; Mohamad Mustafa, 28, received three years. Prosecutors said the two paid kickbacks to a network of marketers who collected DNA samples through telemarketing, health fairs and door-to-door solicitation, then obtained fraudulent test requisition forms from physicians who had no relationship with the patients and never used the results in treatment. Salahaldeen attempted to flee to Mexico after learning of his arrest warrant and was apprehended at the border while presenting someone else's identification. In addition to their prison terms, Salahaldeen was ordered to pay more than $84 million in restitution and Mustafa more than $64 million. Eleven co-conspirators, including three physicians and two nurse practitioners, were previously sentenced in connection with the scheme.

Trump administration’s drug pricing deal projected to save $64.3B over 10 years

The Most Favored Nation framework ties U.S. drug prices to what other high-income countries pay.

The Trump administration said Tuesday its "Most Favored Nation" drug pricing framework is projected to generate $64.3 billion in federal and state savings over the next decade, with broader domestic savings across all markets estimated at $529 billion over the same period. Under the voluntary framework, manufacturers agree to offer new drugs launched in the U.S. at prices comparable to those paid in other high-income countries.

The administration said it has reached MFN pricing agreements with 17 pharmaceutical companies so far, covering Medicaid and cash-paying patients, and expects to extend similar agreements to most manufacturers of sole-source brand name drugs and biologics. The framework also secured price reductions for GLP-1 drugs and expanded Medicare coverage for obesity treatments. The White House described the policy as aimed at equalizing drug prices through a combination of lower U.S. prices and higher prices in other developed countries.

The future of GLP-1s?

Researchers say oral GLP-1 drugs reach deeper into the brain than previously thought, and may curb more than hunger.

National Institutes of Health (NIH)-funded researchers at the University of Virginia have found that oral GLP-1 weight-loss drugs — including the FDA-approved orforglipron — suppress pleasure-driven eating in mice by activating a reward region deep in the brain called the central amygdala, an area scientists did not previously believe this class of drugs could directly reach. The full study is published in Nature.

The finding points to a mechanism separate from the appetite-suppressing pathways that injectable GLP-1s like semaglutide are known to engage. Once triggered, the central amygdala reduced dopamine release in the brain's reward circuitry during eating for pleasure rather than hunger. Researchers say the findings raise the question of whether oral GLP-1s might also reduce cravings for alcohol or other substances, and follow-up studies are planned.

“We’ve known that GLP-1 drugs suppress feeding behavior driven by energy demand. Now it seems oral small-molecule GLP-1s also dial back eating for pleasure by engaging a brain reward circuit,” said co-corresponding author Ali Guler, Ph.D., a professor of biology at the University of Virginia.