A Los Angeles-based doctor just got indicted for one of the most brazen Medicare frauds in recent years: billing for Botox injections that were never administered, didn’t happen on the dates claimed, or happened while the supposed patients were in prison or traveling internationally.
Violetta Mailyan, 45, owned and operated Healthy Way Medical Center. The federal government alleges she submitted more than $45 million in false and fraudulent claims to Medicare for Botox injections that were medically unnecessary and never provided.
This is what healthcare fraud looks like at scale. And it’s a direct theft from the Medicare system that every American funds.
What Botox Actually Is (And When It’s Legitimate)
Before you understand the fraud, you need to understand what Botox actually does and when Medicare should be paying for it.
Botox (onabotulinumtoxinA) is a FDA-approved medication that blocks nerve signals to muscles, temporarily paralyzing them. It’s been used medically for decades—since the 1980s for therapeutic purposes.
Botox is FDA-approved to treat medical conditions including chronic migraines (15+ headache days per month), severe underarm sweating, overactive bladder, strabismus (eye misalignment), and muscle spasticity.
When prescribed by a doctor for legitimate medical conditions, insurance—including Medicare—covers it. When a patient has chronic migraines that don’t respond to medication, Botox injections can be life-changing. When someone has an overactive bladder causing urinary incontinence, Botox can restore function and dignity.
That’s medically necessary Botox.
Then there’s cosmetic Botox—injections for wrinkles and facial lines. Insurance doesn’t cover that. Cosmetic procedures are out-of-pocket.
The fraud: billing Medicare for cosmetic procedures disguised as medical treatment, or billing for injections that never happened at all.
How the Fraud Actually Worked
According to federal prosecutors, Mailyan used a simple playbook repeated across her practice:
She billed Medicare for Botox injections on dates when:
- She was traveling internationally
- The Medicare beneficiary (patient) was traveling internationally
- The Medicare beneficiary was in federal prison
- Healthy Way Medical Center was closed
In other words, she submitted claims for services that were physically impossible to have occurred.
She submitted documentation claiming to have administered injections to patients who couldn’t have been there. She billed for procedures that never happened. She collected payment from Medicare.
The Justice Department calls this wire fraud and obstruction of a criminal investigation. The law calls it theft from a federal program.
The Obstruction Charge: Making It Worse
The indictment includes charges for obstructing a criminal investigation. When federal investigators subpoenaed medical records, Mailyan allegedly submitted falsified documents—fake records claiming procedures happened when they didn’t.
That’s not just billing fraud. That’s obstruction. That’s interfering with a federal investigation by presenting false evidence.
Mailyan is charged with nine counts of wire fraud (maximum 20 years each) and three counts of obstructing a criminal investigation of health care offenses (maximum 5 years each).
If convicted on all counts, she faces decades in federal prison.
Why This Matters
This is a direct theft from the Medicare system. Medicare pays for legitimate medical care provided to eligible beneficiaries. When doctors bill for services never rendered, they’re stealing from the federal program that seniors depend on.
That stolen money doesn’t come from nowhere. It comes from taxpayers. It comes from the pool of money intended for actual patient care. It reduces resources available for legitimate medical treatment.
The Justice Department reports that since 2007, its Health Care Fraud Strike Force program has charged more than 5,800 defendants who collectively billed federal health care programs and private insurers more than $30 billion.
This Mailyan case represents part of that $30 billion in fraudulent billing. One doctor. $45 million. Fake procedures.
What Legitimate Botox Actually Costs
When Botox is genuinely medically necessary:
Medical treatments are often covered by insurance when medically necessary for conditions like chronic migraine, overactive bladder, or cervical dystonia, though prior authorization may be required. Cosmetic treatments typically cost $300-$600 per treatment area and are not usually covered by insurance.
For a patient with chronic migraines, Medicare might approve Botox injections at specific injection sites treating the condition. That’s legitimate. That’s covered. That’s appropriate use of federal healthcare funds.
For someone wanting cosmetic wrinkle reduction? They pay out of pocket. Insurance doesn’t cover it because it’s not medically necessary.
The Red Flags in Mailyan’s Case
Federal prosecutors point to absurdities in her billing that should have triggered investigation sooner:
Claiming to administer injections while traveling: If Mailyan was in another country, she couldn’t have been in her clinic administering injections.
Claiming to treat patients in prison: If a Medicare beneficiary is in federal prison, they’re not receiving outpatient Botox injections at a medical clinic.
Claiming to treat patients while they’re traveling internationally: Same logic—the patient wasn’t present for the procedure.
Billing while the clinic was closed: On days when Healthy Way Medical Center wasn’t operating, somehow Botox injections were being administered?
These aren’t subtle frauds. These are brazen, obvious lies submitted to Medicare with the apparently sincere expectation that federal auditors wouldn’t notice or care.
How This Gets Caught
Medicaid and Medicare fraud is typically caught through:
Claims analysis: Auditors reviewing billing patterns, looking for unusual or impossible claims.
Beneficiary complaints: Patients saying they never received services they’re being billed for.
Whistleblowers: Employees, other doctors, or business partners reporting suspicious activity.
Reconciliation: Comparing dates, locations, and circumstances across billing records to find inconsistencies.
In Mailyan’s case, someone flagged the claims. Federal agents investigated. They found the documentation didn’t match reality. They referred the case to prosecutors.
Now Mailyan faces trial, potential conviction, and federal prison.
The Broader Pattern
This isn’t unique to Mailyan. Healthcare fraud happens across the country in multiple forms:
- Billing for procedures never performed
- Billing for higher-cost procedures than actually provided
- Billing for unnecessary procedures
- Upcoding (billing for more expensive diagnosis codes than appropriate)
- Kickback schemes (paying patients to undergo unnecessary procedures)
The FBI and Department of Health and Human Services Office of Inspector General investigate healthcare fraud specifically because it’s systematic and costly.
Why It Matters for Regular People
Every dollar stolen through healthcare fraud is a dollar not available for legitimate patient care. It’s:
- Money not funding research into treatments
- Money not paying for care for uninsured or underinsured patients
- Money not improving healthcare infrastructure
- Money taxpayers funded but never got benefited from
When doctors commit fraud, everyone else pays. Legitimate healthcare costs go up because fraud inflates the system. Insurance premiums rise. Out-of-pocket costs increase.
The Presumption of Innocence
Mailyan has been indicted, not convicted. An indictment is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law. justice
She will have the opportunity to defend herself, present evidence, and have a trial. The federal government will have to prove its case beyond reasonable doubt.
But the evidence prosecutors have—billing for injections on dates when procedures were impossible—is difficult to defend against.
What Happens Next
Mailyan faces trial. If convicted, she faces potential decades in federal prison. Healthy Way Medical Center will likely face penalties. Restitution will likely be ordered.
The case will send a message to other providers: Medicare fraud gets prosecuted, convictions are obtained, and sentences are substantial.
The Bottom Line
Violetta Mailyan is accused of billing Medicare for $45 million in Botox injections that were never administered. She billed for procedures on dates when the patients weren’t present, when she wasn’t present, when the clinic was closed.
It’s a direct theft from the federal healthcare system that seniors depend on.
When doctors commit fraud, patients suffer, the healthcare system suffers, and taxpayers suffer. The Justice Department is pursuing this case aggressively to hold healthcare providers accountable.
That’s appropriate. That’s necessary. That’s what happens when you attempt to steal from Medicare at scale.
