North Carolina Auditor Flags 47,000% Surge in Medicaid Autism Therapy Billings

North Carolina State Auditor Dave Boliek warned of potential waste, fraud and abuse in the state's Medicaid program, spotlighting a 47,000% increase in autism therapy billings since he took office last year.

In an interview with Fox News Digital from the State Financial Officers Foundation annual conference in Orlando, Boliek said billings for autism therapy rose from about $1.4 million to more than $660 million annually over five years. "Those are vital services to folks and individuals that need that therapy," Boliek said. "But when you have, like in North Carolina, a system that went from $1.4 million or so in total billings for autism therapy to more than $660 million a year in billings on autism therapy within a five-year range, that begs an audit from the state auditor, who in North Carolina, we are the top watchdog agency for taxpayer waste, fraud, and abuse prevention. So we've dug down into that or in the middle of that."

Boliek said his office aligns with Vice President JD Vance's efforts to cut waste, fraud and abuse. He aims to ensure services reach those who need them without wasting money.

One core issue, Boliek said, stems from poor rulemaking that allows multiple clinical providers to bill for the same autism therapy client at once. "What we’ve got is we’ve seen examples where there might be three different clinical providers billing during the same tranche of time on an autism therapy client and that is because of poor rulemaking," he said. "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."

He blamed lax oversight from the Democrat-led North Carolina Department of Health and Human Services, the state's top health agency. "But some of it might be technically legal because of the lax oversight from a Democrat-led Department of Health and Human Services," Boliek said.

Data from the North Carolina Department of Health and Human Services, presented at a March 10, 2026, Joint Legislative Oversight Committee on Medicaid hearing, showed Medicaid spending on Applied Behavior Analysis therapy grew 347% from 2022 to 2025. Total spending is projected to reach $842 million in state fiscal year 2026 and $1.14 billion by state fiscal year 2027.

Medicaid fraud has drawn attention nationwide, including a Minnesota scandal last fall where one suspect allegedly defrauded the autism program of $14 million through fake sessions, untrained staff and payments of $300 to $1,500 monthly to parents. Minnesota's autism program budget rose from $3 million in 2018 to nearly $400 million in 2023, according to Dr. Mehmet Oz, administrator of the federal Centers for Medicare and Medicaid Services.

"The fraud is so obvious, just simply looking at the exponential growth in some of these social services programs, that anybody kind of looking at how fast this was growing should have known that a fraud was a major reason why," Minnesota state Sen. Michael Kreun, a Republican, told Fox News Digital in December.

Boliek said problems arise from billing rules for providers of clinical, daycare and other services paid by health departments. North Carolina still uses fee-for-service models for some services with little transparency on who bills and how much. His office is examining provider data in those areas.

To fight fraud, Boliek's office works with lawmakers to boost financial accountability, expand audits and investigations, and invest in staff and technology. He called artificial intelligence a key tool. "Look, 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."

The State Financial Officers Foundation, which oversees more than $3 trillion in state funds, reported safeguarding $28 billion from waste, fraud and abuse in 2025. "Every wasted dollar is a dollar that can't be spent on a person who actually needs service," Boliek said.