North Carolina State Auditor Dave Boliek says autism therapy billings in his state exploded from roughly $1.4 million to more than $660 million a year inside five years, a 47,000 percent increase that he told Fox News Digital demands a full-scale fraud investigation. The growth pattern mirrors a scandal that already consumed Minnesota's social services budget and drew federal enforcement action.
Boliek, a Republican who took office last year, described the billing surge as a red flag no auditor could ignore. He said his office is now deep into the numbers, and that some of what he's finding may lead to criminal charges.
The core problem, as Boliek frames it, is a Medicaid system where lax rulemaking and fee-for-service billing created an open door for waste and outright fraud. The taxpayers footing the bill had no idea. And the people who genuinely need autism therapy stand to lose the most if the money keeps draining into questionable claims.
Boliek's 47,000 percent figure is striking enough on its own. But the North Carolina Department of Health and Human Services supplied its own data at a March 10, 2026, hearing of the Joint Legislative Oversight Committee on Medicaid, and the department's numbers track with Boliek's account.
That data showed Medicaid spending on Applied Behavior Analysis therapy grew 347 percent between 2022 and 2025 alone. Total spending is projected to reach $842 million in state fiscal year 2026 and $1.14 billion by state fiscal year 2027.
To put it plainly: a program that once cost North Carolina about $1.4 million a year is on pace to consume more than a billion dollars annually within the next fiscal cycle. That trajectory does not happen without either a genuine public-health emergency or a billing system riddled with abuse. Boliek believes it is the latter, or at least a large share of it.
He told Fox News Digital that his office has found cases where three different clinical providers billed for the same autism therapy client during the same window of time. That kind of overlapping billing, he said, flows directly from poor rulemaking.
"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."
Boliek drew a sharp distinction between billing practices that are clearly illegal and those that may be technically legal, but only because the rules were written so loosely that abuse was all but guaranteed. He laid the blame squarely on what he called a "Democrat-led Department of Health and Human Services" in North Carolina.
Some of the billing activity, he said, is "possibly illegal and probably illegal," and his office intends to "try to put people in cuffs because of it." But other patterns may survive legal scrutiny simply because the billing codes and oversight structures were never designed to prevent them.
Boliek described the vulnerability as something embedded in the "minutia of rulemaking", the fine print governing who can bill, how much they can bill, and what documentation is required. He called the result fraud that was effectively "built in by government."
"It really is minutiae, but in North Carolina, for example, we still have some services that are delivered on a fee-for-service basis, and they lack transparency and lack accountability with respect to who can bill and how much can be billed for particular services. That's why we've taken a deep dive into some particular fee-for-service areas in North Carolina and are looking at provider data on exactly how those services are billed. That's where the flaws are."
That last line matters. Boliek isn't just alleging bad actors. He's alleging a system that rewards bad actors by design, one where the rules themselves create the opportunity, and the oversight never catches up.
North Carolina is not the first state to confront this pattern. A Medicaid fraud scandal in Minnesota gained widespread attention last fall, and the parallels are hard to miss.
In Minnesota, the autism-treatment program budget went from $3 million in 2018 to nearly $400 million by 2023, according to figures cited by Dr. Mehmet Oz, the administrator of the federal Centers for Medicare and Medicaid Services. Federal agents discovered that one suspected scammer alone had defrauded the program of roughly $14 million. Parents were allegedly paid between $300 and $1,500 a month to keep their children enrolled.
Minnesota state Sen. Michael Kreun, a Republican, told Fox News Digital in December that the warning signs were visible for years. The FBI's sweeping search warrants at Minneapolis childcare businesses underscored how deeply fraud had penetrated the state's social services infrastructure.
"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."
Kreun's point is damning in its simplicity. When a budget line item jumps from $3 million to $400 million in five years, someone in a position of authority should have asked questions long before federal agents showed up. The guilty pleas now stacking up in Minnesota fraud cases suggest the state's leadership was either asleep or unwilling to look.
The problem extends well past Minnesota and North Carolina. Fox News Digital noted a Daily Wire exposé that found 288 Medicaid companies housed in just seven medical buildings in Columbus, Ohio, entities that collectively billed the government $250 million. That kind of concentration in a handful of addresses is a classic marker of shell billing operations.
The State Financial Officers Foundation, a group whose members collectively oversee more than $3 trillion in state funds, released a report earlier this year outlining how the organization safeguarded more than $28 billion of waste, fraud, and abuse in 2025 alone. Boliek spoke to Fox News Digital while attending the foundation's annual conference in Orlando.
A House committee has already subpoenaed ten states over Medicaid fraud as guilty pleas and nine-figure schemes continue to pile up at the federal level. The scope of the problem is no longer a matter of isolated bad actors. It is systemic.
The North Carolina auditor said his office is working with state lawmakers to strengthen fraud enforcement through several channels: increasing financial accountability, expanding investigative and Medicaid audit resources, and investing in staff and technology to recover misused funds.
Boliek described his approach as "hand-in-hand" with Vice President JD Vance's broader focus on eliminating waste, fraud, and abuse in government spending. The Vance-led anti-fraud task force has already flagged billions in suspect government contracts, and state-level auditors like Boliek appear to be aligning their efforts with the federal push.
One area where Boliek is pressing hard is artificial intelligence. He argued that fraudsters are already using AI to exploit billing systems, and that auditors who fail to match that technology will fall behind.
"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."
That framing, an arms race between scammers and the public officials tasked with catching them, captures the challenge facing every state auditor in the country right now. The old tools are not enough. The billing data is too vast, the schemes too sophisticated, and the money too easy to grab under current rules.
Boliek was careful to note that autism therapy itself is not the problem. The services are real, and the people who need them deserve access.
"Those are vital services to folks and individuals that need that therapy."
But he framed every fraudulent dollar as a direct theft from the people the program was designed to help. His office's goal, he said, is to "make sure that the people who need the services and deserve those services get the services", and to stop the system from "wasting money."
"Every wasted dollar is a dollar that can't be spent on a person who actually needs service."
That is the part of this story that rarely gets enough attention. The victims of Medicaid fraud are not abstract line items in a state budget. They are children with autism whose therapy slots are consumed by phantom patients. They are taxpayers in North Carolina, Minnesota, Ohio, and every other state where these schemes have taken root. And they are the honest providers squeezed by a system that rewards the dishonest ones.
Boliek has not yet named specific providers under investigation in North Carolina, and no criminal charges have been publicly announced. The exact billing codes and rules he contends enable abuse have not been detailed publicly. His office's audit is still in progress.
The North Carolina Department of Health and Human Services presented data at the March 10 hearing that confirmed the spending trajectory Boliek described, but the department has not publicly responded to his characterization of its oversight as "lax." Whether the legislature acts on the auditor's recommendations, or whether the rulemaking failures he identified get fixed, remains to be seen.
What is not in dispute is the math. A program that cost $1.4 million now costs more than $660 million and is heading toward $1.14 billion. Someone is getting rich. The question is whether any of them will face consequences, or whether the system will keep writing checks until the money runs out.
When the rules themselves are the problem, fixing them is not optional. It is the bare minimum a government owes the people paying the bills.
