North Carolina’s numbers are hard to ignore
North Carolina State Auditor Dave Boliek says his office is digging into a steep rise in Medicaid billing for autism therapy, especially ABA, or applied behavior analysis. He points to a jump from about $1.4 million in total billings to more than $660 million over five years. That kind of growth is not a small accounting issue. It is the sort of number that makes any taxpayer wonder whether the state found a hidden need or simply built a payment system with the barn door open. Boliek says his office is the state’s top watchdog for waste, fraud, and abuse, which sounds noble until you remember that watchdogs usually have to bark because somebody left the gate wide open.
Officials say the rules help the problem
Boliek argues the trouble is not just bad actors, but bad design. He says some claims may be illegal, while others could still be technically allowed because the rules are too loose and the oversight too thin. In his view, the system can let multiple clinical providers bill for the same time window on one autism therapy client, which is either a billing mistake, a loophole, or a very creative reading of public money. He says much of the problem sits inside the small print of rulemaking, where fee-for-service programs can be hard to track and easier to abuse. In other words, when government wants complexity, it can produce it on demand.
North Carolina’s health data backs the concern
At a March 10, 2026, hearing of the Joint Legislative Oversight Committee on Medicaid, the North Carolina Department of Health and Human Services presented data that matched the broad trend Boliek described. The report said Medicaid spending on ABA therapy rose 347 percent between 2022 and 2025 and projected total spending of $842 million in state fiscal year 2026 and $1.14 billion in fiscal year 2027. That is not a rounding error. It is a fire alarm. The state’s own figures suggest the program is heading toward a budget line that could swallow attention as fast as it swallows cash, which is often how these things work until somebody asks uncomfortable questions.
Minnesota shows how bad this can get
The concern in North Carolina comes as Medicaid fraud cases in other states keep feeding public distrust. Minnesota has been the latest warning sign, after federal agents reportedly uncovered a scheme that allegedly stole about $14 million from the state’s autism treatment program. Investigators said the case involved fake therapy sessions, untrained staff, and payments to parents ranging from $300 to $1,500 a month to keep children enrolled. That is the kind of scam that thrives when oversight is weak and the money is flowing faster than the checks. Boliek says he wants to make sure real families get real services without waste, fraud, or abuse, which should be the easy part. The hard part is getting a bureaucracy to admit that easy and accountable are not the same thing.
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