North Carolina officials are sounding the alarm after autism therapy billings tied to the state’s Medicaid program surged by roughly 47,000 percent over a five-year span, prompting state investigators to examine whether taxpayer funds were improperly billed through the Medicaid system.
State Auditor Dave Boliek said the dramatic increase has raised concerns that gaps in oversight and confusing reimbursement policies may have opened the door for abuse while legitimate families relying on autism services risk being caught in the fallout.
Boliek revealed that autism therapy billings in North Carolina climbed from roughly $1.4 million annually in 2020 to approximately $660 million per year today.
Speaking to Fox News Digital, Boliek said the increase was too massive to ignore and warranted a full audit by his office, which serves as the state’s chief watchdog agency for taxpayer fraud and abuse prevention.
“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.”
A report from the North Carolina Department of Health and Human Services in March showed Medicaid spending on Research Based Behavioral Health Therapy—which includes applied behavior analysis treatment for autism spectrum disorder—reached hundreds of millions of dollars in recent years and is projected to climb even higher.
According to the report, expenditures are expected to hit $842 million in fiscal year 2026 and surpass $1.1 billion by 2027.
The number of therapy users also jumped sharply, increasing from 3,844 recipients in 2022 to more than 13,000 in 2025, according to the Daily Mail.
State officials acknowledged service growth has expanded much faster than autism diagnosis rates and is unlikely to be explained solely by expanded access to care.
Boliek said investigators are uncovering examples of multiple providers billing Medicaid for services during the same time periods for individual patients, which he blamed on confusing regulations and weak oversight inside 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.
He argued that the state’s fee-for-service structure made it difficult to monitor who was billing Medicaid and whether claims were legitimate.
The North Carolina review arrives amid broader federal efforts to examine Medicaid spending practices across several states.
Boliek said state investigators are working alongside federal officials, including Vice President JD Vance, as authorities examine concerns surfacing in multiple states.
Boliek pointed to investigations elsewhere as examples of how Medicaid systems can be vulnerable to abuse when oversight weakens.
In Minnesota, federal authorities previously uncovered a massive fraud scheme involving pandemic food assistance funds, while separate allegations centered on improper autism therapy billing practices.
Federal investigators have also alleged that some providers improperly billed Medicaid for fake therapy sessions while using unqualified staff members.
Boliek said North Carolina lawmakers are now considering tougher enforcement measures, including larger financial penalties, expanded investigative resources, and increased use of artificial intelligence to 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 said.
He stressed that the investigation is ultimately aimed at protecting vulnerable families who depend on legitimate autism treatment services while ensuring taxpayer dollars are not diverted through fraud or abuse.
“Every wasted dollar is a dollar that can’t be spent on a person who actually needs services,” Boliek said.
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