North Carolina officials have initiated a comprehensive investigation into a staggering 47,000% increase in autism therapy billings tied to the state’s Medicaid program over a five-year period. State Auditor Dave Boliek announced the probe, citing concerns that lax oversight and confusing reimbursement policies may have facilitated widespread abuse of taxpayer funds, while simultaneously jeopardizing legitimate services for vulnerable families. The audit follows a dramatic rise in annual billings for autism therapy, which escalated from approximately $1.4 million in 2020 to an estimated $660 million today.
"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." — Dave Boliek, North Carolina State Auditor
Speaking to Fox News Digital, Boliek emphasized that the unprecedented increase warranted an immediate and thorough audit by his office, which functions as the state’s primary watchdog against taxpayer fraud and abuse. “Those are vital services to folks and individuals that need that therapy,” Boliek stated. “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.”
A March report from the North Carolina Department of Health and Human Services (DHHS) further highlighted the escalating expenditures. The report indicated that Medicaid spending on Research Based Behavioral Health Therapy, which encompasses applied behavior analysis (ABA) treatment for autism spectrum disorder, has reached hundreds of millions of dollars in recent years. Projections within the report estimate these expenditures will climb to $842 million in fiscal year 2026 and surpass $1.1 billion by 2027. Concurrently, the number of therapy recipients has also seen a sharp increase, jumping from 3,844 users in 2022 to over 13,000 in 2025, according to the Daily Mail.
State officials have acknowledged that this rapid growth in service utilization has far outpaced autism diagnosis rates and cannot be attributed solely to expanded access to care. Boliek revealed that investigators are already uncovering instances of multiple providers billing Medicaid for services rendered to individual patients during the same time periods. He attributed these discrepancies to ambiguous regulations and insufficient oversight within the Democrat-led Department of Health and Human Services.
“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 told Fox News Digital, indicating the serious nature of the allegations. He further argued that North Carolina’s fee-for-service structure complicates the monitoring of Medicaid billing and the verification of claim legitimacy.
This state-level review in North Carolina is unfolding amidst broader federal initiatives aimed at scrutinizing Medicaid spending practices across various states. Auditor Boliek confirmed that state investigators are collaborating with federal officials, including Vice President JD Vance, as authorities examine similar concerns emerging in multiple jurisdictions. Boliek cited investigations elsewhere, such as a large-scale pandemic food assistance fraud scheme in Minnesota and separate allegations of improper autism therapy billing in that state, as examples of how Medicaid systems can become susceptible to abuse in the absence of stringent oversight. Federal investigators have also reportedly found cases where providers improperly billed Medicaid for fabricated therapy sessions or utilized unqualified staff.
In response to these findings, North Carolina lawmakers are reportedly considering several tougher enforcement measures. These include the implementation of larger financial penalties for fraudulent activities, the allocation of expanded investigative resources, and an increased reliance on artificial intelligence (AI) to proactively identify suspicious billing patterns. “We’ve got to pour jet fuel on artificial intelligence in the area of state auditing because the fraudsters are using AI,” Boliek emphasized.
Boliek underscored that the ultimate objective of the investigation is to safeguard vulnerable families who depend on legitimate autism treatment services, while simultaneously ensuring that taxpayer dollars are not misdirected through fraud or abuse. “Every wasted dollar is a dollar that can’t be spent on a person who actually needs services,” he concluded, highlighting the critical need to preserve resources for those genuinely in need.
