State auditors and federal watchdogs are raising alarms about potential Medicaid fraud tied to explosive growth in autism therapy billing, with North Carolina emerging as a focal point alongside scandals that previously plagued Minnesota.

North Carolina State Auditor Dave Boliek told Fox News Digital his office has flagged a 47,000% surge in autism therapy billings within the state's Medicaid program since he took office. The sector's total annual billings grew from approximately $1.4 million to more than $660 million over a five-year period, prompting what Boliek called an urgent audit.

"Those are vital services to folks and individuals that need that therapy," Boliek said during an interview at the State Financial Officers Foundation annual conference in Orlando. "But when you have...a system that went from $1.4 million or so in total billings for autism therapy to more than $660 million a year...that begs an audit."

What the Right Is Saying

Republican officials argue the billing patterns are too extreme to ignore and reflect systemic vulnerabilities in how Medicaid is administered.

Boliek, a Republican, said his office has identified cases where three different clinical providers billed for services during overlapping time periods for the same autism therapy client. "Some of it is possibly illegal and probably illegal," he said, adding that his office intends to pursue criminal referrals. He criticized what he called "poor rulemaking" and "lax oversight from a Democrat-led Department of Health and Human Services."

Vice President JD Vance has made eliminating waste, fraud, and abuse in federal spending a priority, and Boliek said his office is coordinating with that effort. Republicans argue that proper oversight protects taxpayers and ensures resources reach those who genuinely need services.

Senate Republican efforts have also focused on closing Medicaid loopholes that allow what they characterize as fraudulent operators to collect millions through schemes involving fake therapy sessions and billing for services never rendered.

What the Left Is Saying

Democratic lawmakers and patient advocates warn against conflating legitimate service growth with fraud, arguing that increased Medicaid spending on autism services reflects expanded access to care mandated by federal law.

Critics note that North Carolina only recently expanded Medicaid under the Affordable Care Act, which naturally increases program enrollment and associated costs. They argue that scrutiny should focus on bad actors rather than restricting services for vulnerable populations who depend on ABA therapy.

Progressive groups contend that scaling up oversight infrastructure takes time, and rapid billing growth alone does not prove fraud. Some Democratic state officials have pointed to the need for better detection systems as programs expand, rather than characterizing exponential spending increases as inherently suspicious.

Additionally, advocates express concern that aggressive anti-fraud campaigns could inadvertently deny care to children who genuinely need autism services, particularly if audits create barriers to providers participating in Medicaid.

What the Numbers Show

Data presented by the North Carolina Department of Health and Human Services at a March 10, 2026 Joint Legislative Oversight Committee on Medicaid hearing confirmed dramatic growth in the sector. Key figures include:

Medicaid spending on Applied Behavior Analysis (ABA) therapy grew 347% between fiscal years 2022 and 2025 alone.

Total ABA therapy spending is projected to reach $842 million in state fiscal year 2026 and $1.14 billion by fiscal year 2027, according to the department's own projections.

In Minnesota, where a major fraud scandal gained widespread attention last fall, investigators discovered that one suspected scammer allegedly defrauded the state's autism-treatment program of approximately $14 million, billing Medicaid for fake therapy sessions and paying parents $300 to $1,500 monthly to keep children enrolled.

Minnesota's state autism program budget increased from $3 million in 2018 to nearly $400 million in 2023, according to Dr. Mehmet Oz, administrator of the federal Centers for Medicare and Medicaid Services.

A recent Daily Wire investigation examined seven medical buildings in Columbus, Ohio, that house 288 Medicaid companies billing a combined $250 million.

The Bottom Line

The surge in autism therapy billings reflects both expanded access to care under Medicaid expansion and potentially systematic abuse by bad actors exploiting regulatory gaps. North Carolina officials say they are pursuing criminal referrals against suspected fraudsters while acknowledging some billing practices may be technically legal due to vague rulemaking. Federal CMS Administrator Oz has characterized the growth patterns as self-evidently suspicious, noting that exponential increases in social services spending should trigger scrutiny. Watch for whether North Carolina's ongoing audit produces criminal charges and whether Congress acts on Republican efforts to close Medicaid loopholes identified across multiple states experiencing similar billing anomalies.