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North Carolina Auditor Probes 47,000% Surge in Medicaid Autism Therapy Billings

The review signals stricter oversight of applied behavior analysis claims under fee-for-service rules.

Overview

  • State Auditor Dave Boliek said autism therapy billings rose from about $1.4 million to more than $660 million in roughly five years and announced audits with potential criminal referrals.
  • North Carolina’s health agency told lawmakers on March 10 that Medicaid spending on applied behavior analysis grew 347% from 2022 to 2025 and could reach $842 million in fiscal year 2026 and $1.14 billion in 2027.
  • Boliek pointed to rule gaps that let multiple providers bill for the same patient at the same time and to fee-for-service payments that he said lack clear limits and tracking.
  • He said his office is working with legislators and federal-aligned efforts to add investigators, expand Medicaid audits, and use artificial intelligence to spot and recover improper claims, with the goal of protecting care for eligible families.
  • Reporters linked the surge to national fraud crackdowns, noting Minnesota’s autism program swelled to nearly $400 million in 2023 as agents alleged fake sessions and kickbacks, while conservative outlets amplified North Carolina’s spike.