The elected state auditor of North Carolina said the value of autism therapy billings to the state’s Medicaid program has increased by roughly 47,000 percent over a five-year period, raising concerns about possible waste, fraud or abuse.
Dave Boliek, who took office last year and oversees the finances of all state agencies, revealed that in 2020, providers billed Health and Human Services about $1.4 million a year for autism therapy services.
According to Boliek, that number has since ballooned to $660 million on an annual basis.
'Those are vital services to folks and individuals that need that therapy,' Boliek said in an interview with Fox News Digital. 'That begs an audit from the state auditor... we are the top watchdog agency for taxpayer waste, fraud, and abuse prevention. So we've dug down into that.'
It's unclear which data set Boliek is referring to, but a March report from the North Carolina Department of Health and Human Services (NCDHHS) says about $544 million in Medicaid funds were spent on 'Research Based Behavioral Health Therapy' in fiscal year 2025.
This kind of therapy is defined as a 'suite of evidence-based interventions that prevents or minimizes the behavioral challenges associated with Autism Spectrum Disorder', according to the report.
By fiscal year 2026, the state's projected expenditures on these services will be $842 million, and in 2027, it is expected to rise to $1.1 billion. The report also shows that there were just 3,844 users of these therapies in 2022 as opposed to 13,447 in 2025.
'Utilization growth far outpaces increases in Autism Spectrum Disorder (ASD) diagnosis,' the report said, adding that it is 'unlikely that this level of growth can be explained by increased access alone.'
North Carolina State Auditor Dave Boliek said state-level Medicaid spending on autism-related therapies has risen 47,000 percent in the last five years
Boliek said he is working with Vice President JD Vance, who has become the Trump administration's point person on fraud investigations, to figure out why costs have ballooned so high
The Daily Mail approached the NCDHHS for comment.
Boliek said he is working 'hand in glove' with Vice President JD Vance on figuring out how these costs are rising so quickly. Vance has become the face of the Trump administration's crackdown on fraud in Minnesota and other states suspected of having faulty programs.
Federal prosecutors have charged dozens of people in the state with stealing roughly $250 million from a pandemic food-aid program, while separate investigations have alleged fraud involving the state’s autism therapy system.
In response, Vance announced in February that the Trump administration froze nearly $260 million in Medicaid funding for Minnesota. The White House has since launched a task force to investigate similar potential fraud schemes in California, Illinois, New York, Maine and Colorado.
In North Carolina, Boliek believes the potential fraud on his hands is due to a general lack of understanding about who is supposed to submit invoices to Health and Human Services. He also said some instances of duplicative billing are likely illegal.
'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 that some of the blame lies with the 'lax oversight' from the NCDHHS, which is led by Dr Devdutta 'Dev' Sangvai. He was appointed to the role last January by Governor Josh Stein, a Democrat.
Boliek emphasized that the murky rules on billing either confuses providers or allows people to take advantage of the complicated system.
Boliek believes that 'lax oversight' from the North Carolina Department of Health and Human Services is partly to blame for costs getting out of control. Dr Devdutta 'Dev' Sangvai (pictured) has led the agency since last year
Governor Josh Stein, a Democrat, appointed Sangvai last January shortly after he was inaugurated
'It really is minutiae... 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,' he said.
'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.'
Boliek said his office is working with lawmakers to strengthen enforcement mechanisms by increasing financial penalties and expanding investigative resources.
One asset Boliek plans to use to uncover fraud is artificial intelligence.
'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,' he said.
These moves, he said, are being made so the right people get the services they need.
'Every wasted dollar is a dollar that can't be spent on a person who actually needs services,' Boliek said.