North Carolina’s Exploding Autism Therapy Billings Makes Minnesota Scammers Look Like Amateurs

In just five years, Medicaid spending on autism therapy in North Carolina has skyrocketed from roughly $1.4 million to $660 million—a staggering 47,000 percent increase that defies any reasonable explanation rooted in population growth or genuine medical need. State Auditor Dave Boliek, the top watchdog for taxpayer dollars in the Tar Heel State, has rightly flagged this as a prime candidate for waste, fraud, and abuse. While applied behavior analysis (ABA) therapy provides real help to children on the spectrum, this kind of exponential billing surge screams for rigorous scrutiny, not blank-check acceptance.

Boliek didn’t mince words in highlighting the anomaly. “Those are vital services to folks and individuals that need that therapy,” he told Fox News. But when billings explode from $1.4 million to more than $660 million annually in five years, “that begs an audit.”

His office is already digging in, coordinating with figures like Vice President J.D. Vance to get to the bottom of it. This isn’t abstract accounting—it’s real money extracted from hardworking North Carolinians and federal taxpayers, funneled into a system showing every hallmark of the fraud patterns exposed elsewhere.

The numbers tell a story far beyond increased awareness or diagnosis rates. Beneficiary counts have risen sharply, but not nearly enough to justify the fiscal explosion. Spending on ABA services jumped 347 percent between 2022 and 2025 alone, with projections now topping $1 billion by 2027. Average per-patient costs hover near $37,600 annually in recent data, and some providers are raking in tens of millions each. Meanwhile, fraud investigations tied to these services have more than doubled. Patterns like this echo the Feeding Our Future scandal in Minnesota, where fabricated claims drained hundreds of millions from programs meant for children.

This isn’t the first red flag in America’s Medicaid programs. Similar spikes have drawn audits in multiple states, revealing everything from overbilling to ineligible claims. In North Carolina, a red state with conservative leadership, the discovery underscores a sobering reality: bureaucratic bloat and profit-driven incentives can infiltrate even well-intentioned programs, regardless of the governing party’s label. The left often portrays any push for accountability as an attack on the vulnerable. Yet ignoring these red flags actually harms the very families relying on legitimate care by draining resources and eroding public trust.

Critics of oversight will claim rising autism diagnoses explain everything. Diagnosis rates have indeed climbed nationally, but a 47,000 percent billing jump stretches credulity. No epidemic spreads that fast, and no therapy suddenly requires that much more per child without corresponding evidence of improved outcomes or expanded eligibility that matches the dollars. More likely, a combination of loosened standards, aggressive marketing by providers, telehealth loopholes, and weak verification has opened the floodgates. Some providers entered the market solely for Medicaid gold, with little prior footprint in the state.

State officials have begun moves to rein in costs—tighter documentation, supervision requirements, and rate reviews. These steps are welcome but overdue. Taxpayers deserve assurance that funds reach children who need them, not entrepreneurial operators gaming the system. Constitutional principles of limited government and fiscal stewardship demand nothing less. When unelected administrators and private interests drive Medicaid toward insolvency, elected leaders must intervene decisively.

The pattern repeats across entitlement programs: initial compassion expands into unchecked growth, inviting abuse that burdens future generations. North Carolina’s experience serves as a microcosm of national challenges. With federal involvement in Medicaid, the stakes extend beyond Raleigh. Waste here compounds deficits that future taxpayers—many of them the very children this therapy aims to help—will inherit.

As Scripture reminds us in James 1:27, “Pure religion and undefiled before God and the Father is this, To visit the fatherless and widows in their affliction, and to keep himself unspotted from the world.”

True care for the vulnerable requires integrity in stewardship, not blind expansion of spending that invites corruption. North Carolinians, and Americans watching similar trends nationwide, should demand full transparency and reforms that protect both children with autism and the public purse. Anything less betrays the trust placed in those who manage these vital programs.