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North Carolina Auditor Sounds Alarm on Explosive Growth in Medicaid Autism Therapy Billing
North Carolina State Auditor Dave Boliek is warning of potential widespread fraud in the state’s Medicaid program, particularly pointing to a staggering 47,000% increase in autism therapy billings over a five-year period.
“Those are vital services to folks and individuals that need that therapy,” Boliek told Fox News Digital. “But when you have a system that went from $1.4 million or so in total billings for autism therapy to more than $660 million a year within a five-year range, that begs an audit from the state auditor.”
As the state’s self-described “top watchdog agency for taxpayer waste, fraud, and abuse prevention,” Boliek’s office is currently investigating the dramatic surge in autism therapy costs. His concerns echo a nationwide trend of increased scrutiny on Medicaid fraud across multiple states.
Data presented by the North Carolina Department of Health and Human Services in March confirmed this explosive growth, showing that Medicaid spending on Applied Behavior Analysis (ABA) therapy grew by 347% between 2022 and 2025 alone. The report projects total spending to reach $842 million in state fiscal year 2026 and $1.14 billion by fiscal year 2027.
Boliek identified several concerning issues in his investigation, including instances where “three different clinical providers [were] billing during the same tranche of time on an autism therapy client.” He attributed this to “poor rulemaking” and “lax oversight” from state health authorities.
“Some of it is possibly illegal and probably illegal, and we’re going to point that out, and we’re going to try to put people in cuffs because of it,” Boliek stated firmly.
The North Carolina situation parallels the high-profile Medicaid fraud scandal that erupted in Minnesota last year, where federal agents uncovered that one suspected scammer had defrauded the state’s autism treatment program of approximately $14 million. That scandal involved alleged billing for fake therapy sessions, use of untrained staff, and payments to parents to keep their children enrolled in programs. Minnesota’s autism program budget skyrocketed from $3 million in 2018 to nearly $400 million in 2023.
Similar fraud concerns have spread to other states including California and Ohio. A recent investigation by The Daily Wire exposed a network of 288 Medicaid companies housed in just seven medical buildings in Columbus, Ohio, collectively billing the government $250 million.
According to Boliek, the vulnerability of Medicaid to abuse stems from the “minutia of rulemaking” built into government systems. He specifically highlighted fee-for-service payment models still used in North Carolina that “lack transparency and lack accountability with respect to who can bill and how much can be billed for particular services.”
The auditor indicated his office is collaborating with lawmakers to strengthen fraud enforcement through several initiatives: increasing financial accountability, expanding investigative and Medicaid audit resources, and investing in staff and technology to recover misused funds.
Boliek also emphasized the critical role of artificial intelligence in combating fraud. “We’ve got to pour jet fuel on artificial intelligence in the area of state auditing because the fraudsters are using AI, and if we’re not using AI to combat the fraud, then we’re going to be on our heels and the taxpayer isn’t going to be protected.”
His office’s efforts align with Vice President JD Vance’s focus on eliminating waste, fraud, and abuse in government programs to ensure resources reach those truly in need. Boliek was speaking from the State Financial Officers Foundation annual conference, an organization that reportedly safeguarded more than $28 billion from waste, fraud, and abuse in 2025 alone.
“Every wasted dollar is a dollar that can’t be spent on a person who actually needs service,” Boliek concluded, underscoring the human impact of unchecked fraud in vital social service programs.
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10 Comments
This is a troubling trend that requires urgent attention. Medicaid is a lifeline for millions, so ensuring the proper use of these funds is paramount. I’m glad to see state auditors taking an active role in scrutinizing these billing irregularities and working to strengthen oversight.
Kudos to the North Carolina auditor for sounding the alarm and launching an investigation. Medicaid spending is a significant portion of state budgets, so rooting out any fraudulent activities is crucial to ensure these vital funds are used responsibly and reach the people who need them most.
Agreed, this kind of proactive oversight is exactly what’s needed to maintain the public’s trust in Medicaid and other social programs.
These concerning trends of surging Medicaid costs and potential fraud seem to be emerging across multiple states. It’s critical that state and federal authorities work together to enhance oversight, improve transparency, and put stronger safeguards in place to protect the integrity of these essential social programs.
This is certainly concerning. Medicaid fraud erodes public trust and diverts crucial funds away from the vulnerable populations these programs are meant to support. A thorough investigation is warranted to get to the bottom of these billing irregularities and ensure proper oversight and accountability.
It’s disheartening to see Medicaid fraud seemingly becoming more prevalent across multiple states. This not only wastes taxpayer money but also undermines the ability of these programs to effectively serve vulnerable populations. I hope the investigations uncover the root causes and lead to meaningful reforms.
While the intent behind expanded Medicaid coverage and autism therapy access is admirable, these concerning patterns of skyrocketing costs and potential abuse need to be taken seriously. Rigorous audits and tighter controls are essential to uphold the integrity of these critical healthcare safety nets.
A 47,000% increase in autism therapy billings over just 5 years is staggering and raises major red flags. While these therapies are vital, such explosive growth demands close scrutiny to root out any potential fraud or abuse of the system. I hope the state auditor’s investigation provides much-needed clarity.
While the increase in autism therapy access is positive, the astronomical billing growth is highly concerning. State and federal authorities must collaborate closely to investigate these issues, implement robust anti-fraud measures, and safeguard the integrity of Medicaid for those who rely on it most.
Absolutely. The intention behind expanded coverage is admirable, but the system must have the proper controls in place to prevent abuse and ensure funds are used as intended.