As concerns over fraud continue to increase across the United States, especially as it pertains to the Medicaid program, North Carolina State Auditor Dave Boliek spoke with Fox News, saying the issue is a huge problem in his state. Boliek noted this is particularly true of autism therapy, an area that has also been under scrutiny in the deeply troubled state of Minnesota.
Boliek is raising alarms about potential waste, fraud, and abuse, within North Carolina’s Medicaid program, pointing out in a recent interview with Fox News that a 47,000% explosion in autism therapy billings has been flagged since he took office in 2025. “Those are vital services to folks and individuals that need that therapy,” he 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 from the state auditor, who in North Carolina, we are the top watchdog agency for taxpayer waste, fraud and abuse prevention,” Boliek explained.
“So, we’ve dug down into that and are in the middle of that,” he added. The state auditor, who spoke with Fox News during the State Financial Officers Foundation conference in Clearwater, Florida, revealed that his office is working “hand in hand” with Vice President JD Vance’s task force on cutting waste, fraud, and abuse to “make sure that the people who need the services and deserve those services get the services” without “wasting money.”
Boliek said that one of the biggest issues his state faces is that the system is often designed in such a way that it is not able to properly protect against waste and abuse. “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,” he 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,” Boliek added. “But some of it might be technically legal because of the lax oversight from a Democrat-led Department of Health and Human Services,” the state auditor said, making a reference to the top state health agency in his state.
In a hearing of the Joint Legislative Oversight Committee on Medicaid held on March 10, 2026, the North Carolina Department of Health and Human Services presented information that matched Boliek’s statements about exponential growth in autism therapy. Fox stated that the report confirmed that Medicaid spending on applied behavior analysis therapy exploded by 347% between 2022 and 2025.
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The report also revealed that spending in this area is projected to hit $842 million in fiscal year 2026 and balloon even more, hitting $1.14 billion by fiscal year 2027. Boliek later stated that critical issues with the Medicaid program and the ease with which it can be abused both legally and illegally are contained in the “minutiae of rulemaking” that is “built in by government.”
“For example, how individual entities, whether they are a provider of clinical medical services or whether they’re a provider of daycare services or other services that can be paid for through departments of Health and Human Services, how those rules are set up and what the billing rules are,” Boliek said during his conversation with Fox.
“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,” he continued.