As Americans grow increasingly frustrated with government waste and runaway entitlement spending, a shocking new report out of North Carolina is raising serious questions about how taxpayer dollars are being spent — and potentially abused — inside the Medicaid system.
According to North Carolina State Auditor Dave Boliek, billings for autism therapy under the state’s Medicaid program have exploded by an astonishing 47,000% in just a few years, triggering a major investigation into potential fraud, abuse, and bureaucratic incompetence.
Boliek, who spoke with Fox News during the State Financial Officers Foundation conference in Florida, said the dramatic increase demands immediate scrutiny from state watchdogs.
“These are vital services to folks and individuals that need that therapy,” Boliek explained. “But when you have a system that went from roughly $1.4 million in autism therapy billings to more than $660 million a year within about five years, that begs an audit.”
And that audit is now underway.
For conservatives who have long warned that bloated government programs often become magnets for fraud and abuse, the revelations are yet another example of what happens when massive taxpayer-funded systems lack accountability and oversight.
Boliek made it clear that legitimate families seeking autism treatment for their children should absolutely receive support. But he also warned that weak regulations and sloppy rulemaking may have opened the floodgates for bad actors to exploit the system.
“What we’ve seen are examples where there might be three different clinical providers billing during the same tranche of time on an autism therapy client,” Boliek said.
In plain English: multiple providers appear to be billing taxpayers simultaneously for the same patient during overlapping time periods.
Some of those cases, Boliek warned, may be outright criminal.
“Some of it is possibly illegal and probably illegal,” he stated bluntly. “And we’re going to point that out, and we’re going to try to put people in cuffs because of it.”
At the same time, the auditor argued that much of the problem stems from lax oversight by the Democrat-led Department of Health and Human Services, which he says created a system riddled with loopholes and vague billing rules.
That concern is backed up by data presented earlier this year to North Carolina’s Joint Legislative Oversight Committee on Medicaid. According to the report, Medicaid spending on applied behavior analysis therapy skyrocketed by 347% between 2022 and 2025 alone.
Even more alarming, projections show spending could balloon to $842 million in fiscal year 2026 and exceed $1.1 billion by 2027.
Critics argue this is exactly what happens when government expands programs without implementing strict accountability measures.
Boliek emphasized that the biggest vulnerabilities often hide deep inside complicated regulations that few ordinary taxpayers ever see.
“It really is minutiae,” he explained. “But the rules are built in by government.”
Those rules determine who can bill Medicaid, how much they can charge, and what oversight exists to catch abuse. According to Boliek, North Carolina’s fee-for-service structure lacks transparency and makes it far too easy for questionable billing practices to flourish unchecked.
The investigation also comes as Republican leaders nationwide intensify efforts to root out fraud in federal and state entitlement programs. Boliek revealed that his office is working closely with Vice President JD Vance’s task force focused on eliminating waste, fraud, and abuse in government spending.
The goal, he said, is simple: protect vulnerable citizens who genuinely need services while ensuring taxpayer dollars aren’t being siphoned away by fraudsters or bureaucratic failures.
For many Americans already burdened by inflation, rising healthcare costs, and mounting national debt, the North Carolina findings reinforce a growing concern: government programs too often prioritize expansion over accountability.
And as this investigation unfolds, taxpayers may soon learn just how deep the problem really goes.
