North Carolina State Auditor Dave Boliek says his office is closely examining the surge in Medicaid-funded autism therapy costs, as lawmakers and state officials confront a projected billion-dollar increase over the coming years.
Boliek’s comments, made in a recent interview with Fox News, come as North Carolina legislators continue examining dramatic increases in spending on applied behavior analysis (ABA) therapy, a treatment for children with autism spectrum disorder.
“Those are vital services to folks and individuals that need that therapy,” Boliek told Fox News. “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 and are in the middle of that.“
As previously reported by the Carolina Journal, data presented to lawmakers at a March 10 meeting of the Joint Legislative Oversight Committees on Health and Human Services and Medicaid showed that spending on autism therapy services surged by 347% from 2022 to 2025.
During this period, the number of children receiving services is expected to grow from 3,844 to 13,447. In addition, the average number of patient care hours per month will rise from 47.5 to 54.1. Lawmakers noted that both the increased number of children served and the higher intensity of treatment contribute to the rapid growth in spending.
Boliek said national reports of Medicaid fraud involving autism therapy providers in other states prompted his office to begin scrutinizing North Carolina’s numbers more closely.
“We want to make sure that taxpayer dollars are being spent appropriately, that services are being rendered appropriately, and that children who need these services are actually receiving them.”
Boliek emphasized that his office has not uncovered evidence of the same widespread fraud schemes alleged elsewhere, but said the rapid increase in spending demands attention. He said that, while issues may still exist, “we did not see the type of spike that we did in Minnesota in other areas of North Carolina government.”
Boliek said part of the concern involves weaknesses in the Medicaid oversight system itself, which he argued can allow questionable billing practices.
“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,” Boliek told Fox News. “That is because of poor rulemaking.”
He said weak oversight within the Department of Health and Human Services makes questionable billing possible, increasing concern about oversight gaps.
“Some of it might be technically legal because of the lax oversight from a Democrat-led Department of Health and Human Services,” Boliek said.
The renewed scrutiny follows national attention on alleged Medicaid fraud schemes involving autism therapy providers in Minnesota, where spending on autism services reportedly increased from less than $1 million in 2018 to more than $340 million in 2024.
A Department of Justice report, cited by Fox News, alleged that fraudsters recruited families into autism treatment programs, helped obtain questionable diagnoses, and billed Medicaid for services that were unnecessary or never provided.
Boliek said his office is already working with lawmakers on potential reforms to strengthen Medicaid fraud enforcement and improve oversight.
According to Boliek, those efforts include increasing financial accountability measures, expanding Medicaid audit and investigative resources, and investing in additional staff and technology to help recover misspent taxpayer dollars.
He emphasized accountability efforts, saying, “If there are bad actors, we want to identify them. If there are gaps in oversight, we want to fix them.”
Boliek also pointed to artificial intelligence as a critical tool in combating increasingly sophisticated fraud schemes.
“Look, we’ve got to pour jet fuel on artificial intelligence in the area of state auditing because the fraudsters are using AI,” Boliek told Fox News. “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.”
