Health care on the ballot; Botox billing doctor gets 15 years; Medicare prior auth pilot curbs services — Morning Medical Update

Health care on the ballot

Physicians, nurses and community clinics are all in play on Election Day.

At least 125 doctors, nurses and public health experts are on the ballot in today's midterm elections, a number CNN called unprecedented.

In California, voters will decide Proposition 44, which would require private nonprofit community clinics, known as federally qualified health centers, to spend at least 90% of their revenue each year on health care services.

SEIU-United Healthcare Workers West, the union behind the measure, says clinics should spend more on patient care and less on executive pay and overhead. Opponents, including the California Medical Association and the California Primary Care Association, say clinics are already heavily regulated and estimate the measure would cost them more than $1.7 billion in noncompliance fees in its first year.

Also on the California ballot is Proposition 40, a one-time tax of up to 5% on billionaires' assets. The state's Legislative Analyst's Office says 90% of the money would have to be spent on health care services.

California doctor gets 15 years for $45M in Medicare Botox billing

Prosecutors said she billed for injections on days her clinic was closed.

Violetta Mailyan, 45, of Glendale, California, was sentenced Oct. 29 to 15 years in federal prison for billing Medicare more than $45 million for Botox injections that were medically unnecessary or never provided, the U.S. Justice Department said.

Mailyan owned Healthy Way Medical Center, which presented itself as a beauty and cosmetic clinic. Medicare covers the injections only for documented chronic migraines, but prosecutors said she billed for cosmetic treatments, for patients never referred for migraine care and for injections on days the clinic was closed or while she was traveling.

A jury convicted her in May on nine counts of wire fraud and three counts of obstructing a criminal investigation of a health care offense. Prosecutors said she falsified medical records and forged beneficiary signatures, including for a man who was in federal prison when he was supposedly treated.

She was ordered to pay $32.9 million in restitution to Medicare and forfeit more than $16 million in seized property. Prosecutors said she spent proceeds on luxury items, including a $12,000 17th-century crossbow.

Medicare prior authorization pilot curbs targeted services, study finds

Researchers can't yet say whether the care that didn't happen was wasteful or needed.

Use of services targeted by Medicare's Wasteful and Inappropriate Service Reduction (WISeR) model fell 15% to nearly 20% in the pilot's first six months compared with states outside it, according to a research letter published Oct. 26 in JAMA.

The six-year pilot, which launched in January in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, adds prior authorization to traditional Medicare. The companies that run the reviews are encouraged to use artificial intelligence.

Epidural steroid injections fell 15%, but the effect faded, with the reduction shrinking from about 21% in the first quarter of 2026 to about 9% in the second. Services originally slated for the pilot but never added showed no significant change.

The study, by Hannah T. Neprash, Ph.D., of the University of Minnesota School of Public Health, and Michael L. Barnett, M.D., M.S., of Brown University School of Public Health, could not determine whether the forgone care was unnecessary or needed.