North Carolina’s top bean-counter says the Medicaid system is starting to look less like a safety net and more like an ATM with no security guard.
State Auditor Dave Boliek is waving a giant red flag over a staggering explosion in autism therapy billing under Medicaid — a spending spike so massive even veteran budget hawks are doing double takes.
The numbers are eye-popping: North Carolina reportedly went from roughly $1.4 million in autism therapy billings to more than $660 million annually in just five years. That’s not a typo. It’s a roughly 47,000% jump in a program that was supposedly designed to help vulnerable kids — not create a taxpayer-funded feeding frenzy.
“Those are vital services to folks and individuals that need that therapy,” Boliek told Fox News Digital. “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.”
And Boliek says his office is digging in hard.
The Republican auditor, speaking from a financial officers conference in Orlando, said his office is working “hand-in-hand” with Vice President JD Vance’s push to root out government waste and fraud before Medicaid turns into a bottomless pit of public cash. The era of “just trust the billing paperwork” may finally be ending.
Boliek says the scandal isn’t simply about a few crooked operators gaming the system. In his view, the problem is baked directly into the bureaucracy itself.
“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 said.
“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.”
But Boliek also argued some of the abuse may technically fall within existing rules because oversight has been so lax. He pointed a finger squarely at the Democrat-led state health bureaucracy, accusing regulators of creating a system with weak safeguards and little accountability.
And North Carolina isn’t exactly alone. Across the country, Medicaid has become the latest magnet for fraud allegations as investigators uncover bizarre billing schemes and explosive spending growth. Minnesota became ground zero for national outrage after federal investigators alleged massive fraud tied to autism treatment programs and social services spending.
One suspect in Minnesota allegedly pocketed roughly $14 million by billing Medicaid for bogus therapy sessions, using untrained workers and even paying parents monthly kickbacks to keep children enrolled, according to investigators.
Meanwhile, the cost of Minnesota’s autism program reportedly ballooned from about $3 million in 2018 to nearly $400 million by 2023 — another spending rocket ship that somehow escaped serious scrutiny until investigators came knocking.
“The fraud is so obvious,” Republican Minnesota state Sen. Michael Kreun said last year. “Anybody kind of looking at how fast this was growing should have known that a fraud was a major reason why.”
North Carolina lawmakers are now staring down similar warning signs.
According to figures presented to the state’s Joint Legislative Oversight Committee on Medicaid earlier this year, spending on Applied Behavior Analysis therapy surged 347% between 2022 and 2025 alone. Projections show costs could hit $842 million in fiscal year 2026 and then blow past $1 billion the following year.
That kind of trajectory has conservatives asking an uncomfortable question: How many more “emergency spending increases” are actually fraud alarms nobody wanted to hear?
Boliek argues the real problem lies in the tedious but enormously consequential “minutia of rulemaking” inside Medicaid — the obscure billing regulations and reimbursement structures that few taxpayers ever see but which determine how billions get spent.
“It really is minutiae,” he explained, noting that some fee-for-service programs still lack basic transparency over who can bill and how much they can charge.
Critics say that’s exactly how government waste metastasizes: complicated systems, weak oversight and politicians terrified of asking tough questions lest they get accused of “cutting services.”
Now auditors are racing to catch up — and they’re turning to artificial intelligence to do it.
“Look, we’ve got to pour jet fuel on artificial intelligence in the area of state auditing because the fraudsters are using AI,” Boliek warned. “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.”
In other words, the scammers have upgraded to the digital age while much of government is still pushing paperwork.
Boliek says his office is working with lawmakers to beef up Medicaid audits, expand investigative teams and recover misspent taxpayer dollars before even more money disappears into the bureaucratic abyss.
And for taxpayers watching billion-dollar social programs balloon while roads crumble and deficits rise, his final warning may hit hardest:
“Every wasted dollar is a dollar that can’t be spent on a person who actually needs service.”
