A California physician was sentenced to 15 years in prison after using her medical practice to submit more than $45 million in fraudulent Medicare claims for Botox treatments, the Justice Department said. The sentence was imposed on Oct. 29 following a trial involving evidence that thousands of the claimed injections were never performed or did not qualify for Medicare coverage.
Medicare may cover Botox injections when they are medically necessary to treat documented chronic migraines. According to court records and trial evidence described by the Justice Department, Violetta Mailyan, 45, owned and operated Healthy Way Medical Center in Glendale, California. The clinic presented itself as a provider of beauty and cosmetic services.
Claims included treatments that did not occur
Prosecutors said Mailyan billed Medicare for injections that were allegedly given for cosmetic purposes, rather than for covered migraine treatment. Other claims involved patients whose primary care doctors had not referred them for chronic-migraine care. The case also included claims for procedures that were not performed at all.
| Alleged billing conduct | Amount or detail reported |
|---|---|
| Total fraudulent Medicare billing | More than $45 million |
| Claims for injections on days the clinic was closed | More than $19 million |
| Claims while Mailyan was in Cabo | More than $200,000 |
The evidence showed that Mailyan submitted claims for thousands of injections on days when the clinic was closed. The Justice Department also said she billed for treatments while traveling to Mexico, Hawaii, Las Vegas, Pennsylvania and New York. In one example cited in the case, she sought more than $200,000 for supposed services in California while she was at a beach in Cabo.
Records were altered, prosecutors said
When federal investigators began closing in, Mailyan allegedly attempted to conceal the scheme by changing medical records and forging Medicare beneficiaries’ signatures. The Justice Department said one forged record concerned a man who was in federal prison during the period when Mailyan claimed to have treated him. She submitted the records to investigators, prosecutors said, in an effort to make it appear that the appointments had occurred.
The case also showed how Medicare billing fraud can involve more than a disputed treatment code. Investigators and the court examined the clinic’s operating schedule, Mailyan’s travel and patient documentation when assessing whether the claimed services had taken place. The alleged conduct included claims for medically unnecessary care as well as for procedures that were never delivered.
Luxury purchases cited in the case
The Justice Department said Mailyan used proceeds from the scheme to buy luxury items, including a $12,000 17th-century crossbow and a $3,000 painting. Those purchases were presented as evidence of how she used money obtained through the Medicare billing operation.
- Mailyan was sentenced on Oct. 29 to 15 years in prison.
- The government said Healthy Way Medical Center billed Medicare more than $45 million for Botox services.
- The claims included cosmetic treatments, unsupported migraine treatments and injections that were never provided.
The sentence represents a completed court action in a case involving federal health-program funds. Medicare beneficiaries generally receive care through providers that submit claims to the program, making accurate treatment records and billing information central to the program’s payment process.
