Concerns about Medicaid fraud are intensifying, with North Carolina at the forefront. State Auditor Dave Boliek has flagged significant issues, particularly regarding the explosion of billings for autism therapy. Boliek’s revelations, shared in an interview with Fox News, underscore the alarming growth in this area. He pointed out that since he took office in 2025, the billings for autism therapy have skyrocketed an astonishing 47,000%. This dramatic increase raises serious questions about oversight and accountability within the state’s Medicaid program.
“When you have, like in North Carolina, a system that went from $1.4 million to more than $660 million in just five years, that begs an audit,” Boliek stated. His role as the leading watchdog for taxpayer funds emphasizes the need for a thorough investigation into this financial surge. He noted, “Those are vital services to folks and individuals that need that therapy,” indicating that the stakes are high, not just in terms of dollars but also in providing necessary care for those in need.
Boliek’s collaboration with Vice President JD Vance’s task force highlights a proactive approach aimed at identifying and cutting waste and fraud. “We’re working hand in hand to make sure that the people who need the services and deserve those services get the services,” he explained, emphasizing the goal of protecting essential therapies while rooting out inefficiencies that squander taxpayer resources.
One of Boliek’s key complaints is the design of the system itself, which he claims fails to prevent abuse. He mentioned instances where different clinical providers billed for services rendered to the same client simultaneously, an indicator of serious oversight failures. “Some of it is possibly illegal and probably illegal… But some of it might be technically legal,” he cautioned, attributing part of the issue to “lax oversight” from the state’s Department of Health and Human Services. This statement sheds light on systemic problems within state agencies that may be exacerbating the situation.
Evidence backing Boliek’s claims emerged during a Joint Legislative Oversight Committee hearing on Medicaid. Reports from the North Carolina Department of Health and Human Services confirmed a staggering 347% increase in Medicaid spending on behavioral analysis therapy between 2022 and 2025. Projections indicate a rise to $842 million in fiscal year 2026, with continued increases expected thereafter.
Boliek emphasized that these alarming trends stem from what he termed the “minutiae of rulemaking” inherent in government operations. He described how poorly defined rules regarding billing practices can lead to widespread abuse, both legal and illegal. “For example, how individual entities… how those rules are set up and what the billing rules are,” he explained, reinforcing the idea that these complex regulations often provide loopholes that can be exploited.
Despite the apparent flaws, Boliek’s office is taking steps to drill down into these fee-for-service areas, analyzing data to uncover specific instances of misuse. “That’s where the flaws are,” he pointed out, indicating that meticulous examination of provider data is essential in pinpointing where these issues originate.
The situation in North Carolina serves as a cautionary tale for Medicaid programs nationwide. Boliek’s insights bring attention to the pressing need for more robust oversight mechanisms to protect taxpayer dollars and ensure that vital services reach the community members who need them most. With heightened scrutiny and ongoing investigations, the path forward will demand vigilance and accountability to restore public confidence in the system.
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