Compliance-book author sentenced in $136M Medicare fraud; lose sleep, gain weight; inside the brain's growth-hormone circuit — Morning Medical Update

Compliance-book author sentenced in $136M Medicare fraud

Jean Wilson sold signed orders for medically unnecessary braces at about $90 per Medicare beneficiary.

Jean Wilson, 54, of Richmond Hill, Georgia, a licensed nurse practitioner who owned two telemedicine companies, was sentenced to 10 years in prison for a scheme that billed Medicare more than $136 million for medically unnecessary orthotic braces and prescription drugs. Prosecutors said Wilson and others paid kickbacks to clinicians to sign orders for braces and drugs that beneficiaries did not need, and that Wilson signed many herself.

She sold the signed orders to marketing companies for about $90 per beneficiary, which resold them to brace suppliers and pharmacies that billed Medicare. The program paid more than $66 million on the false claims, and Wilson and her husband, Reinaldo Wilson, spent the proceeds on luxury vehicles, including multiple Rolls-Royces. After her arrest, Wilson marketed herself as a health care compliance consultant and wrote several books on the subject. She was ordered to pay $66 million in restitution.

Lose sleep, gain weight

Adults who lost about 80 minutes of sleep a night gained weight and moved less over six weeks, a randomized Columbia study finds.

Cutting sleep by a modest amount led to weight gain in adults, researchers at Columbia University reported. In a pooled analysis of randomized trials published July 6 in Annals of Internal Medicine, 95 adults who normally sleep seven to eight hours pushed their bedtime 90 minutes later for six weeks, cutting actual sleep by about 80 minutes a night, and slept normally during a separate six-week phase.

During the short-sleep phase, participants gained an average of about 1 pound and became more sedentary, adding roughly 17 minutes of inactivity a day overall and nearly 30 minutes among men and postmenopausal women. "When extrapolated to a full year, we would expect that losing less than an hour and a half of sleep per night could result in clinically meaningful weight gain," said first author Faris Zuraikat, an assistant professor of nutritional medicine at Columbia. The chronic, mild sleep loss the study modeled affects roughly 30% of adults, the authors said.

Inside the brain's growth-hormone circuit

A mouse study maps the hypothalamic neurons that release growth hormone during sleep and the feedback loop that nudges the brain back awake.

Sleep is known to raise growth hormone release, but the brain circuit responsible had not been worked out. In a study in mice published in Cell, researchers at the University of California, Berkeley, mapped how two groups of hypothalamic neurons, one stimulatory and one inhibitory, drive the hormone's release during sleep, with different activity patterns in REM and non-REM stages. They also identified a negative feedback loop not described before: growth hormone released during sleep increases the excitability of noradrenergic neurons in the locus coeruleus, a wake-promoting region, and nudges the brain toward waking.

"People know that growth hormone release is tightly related to sleep, but only through drawing blood and checking growth hormone levels during sleep," said first author Xinlu Ding, a postdoctoral researcher at UC Berkeley. "We're actually directly recording neural activity in mice to see what's going on." The findings are mechanistic and test no therapy; how closely the circuit maps onto human physiology is the open question.