By admin 
RALEIGH, N.C. (WNCN) — A dramatic spike in Medicaid billing for autism therapy services is under investigation in North Carolina, as state auditors dig into whether the surge reflects growing demand, fraud, or a combination of both.
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State Auditor Dave Boliek told CBS 17 his office found applied behavior analysis (ABA) therapy billings grew from $6 million in 2021 to $660 million in 2025. That’s an increase of about 11,000% in four years.
“These are rocket ship-type spikes,” Boliek said. “It immediately raises the attention that we need to take a look at it and see what’s going on here.”
ABA therapy is an evidence-based treatment commonly used to help children with autism develop communication, behavioral, and social skills.
Boliek said investigators are reviewing providers, billing practices, and determining whether or not Medicaid rules are being followed. He said the audit will also review whether physical locations exist and whether billing claims are legitimate.
But he stressed his office has not found fraud at this point.
“You don’t find fraud by flicking on or off a light switch. It requires investigation, and it requires a deep dive,” Boliek said. “You don’t want to accuse any provider or any organization or individual of fraud without having proof of that fraud.”
The audit is part of the Medicaid rebase law. It adds tighter oversight for ABA providers, including stricter billing requirements, more supervision standards, and limits on certain telehealth services.
“These are not bad suggestions that have been put into the law. It’s probably necessary,” said David Laxton, communications director of Autism Society of North Carolina.
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Laxton said 35,000 kids with autism receive ABA therapy. That’s twice as many kids who received services 10 years ago. He said that growth is driven by more autism diagnoses, expanded insurance coverage, and more providers entering the field.
“Sometimes multiple things can be true at once,” Laxton said.
Laxton said the organization supports efforts to remove bad actors from the system.
“If somebody has hung up a sign and saying they’re offering services and they’re not doing it, well obviously we want to get those people out of the system,” he said.
Boliek said the goal of the audit is to make sure taxpayer dollars are reaching children who need services.
“Every single taxpayer dollar that either gets wasted or is a result of fraud is a taxpayer dollar that can’t go to an individual that really needs and will benefit from these therapy services,” he said.
Boliek did not provide a timeline for when the audit could be completed, but said his office is working with other state auditors and federal partners as part of a broader effort to end waste, fraud and abuse in Medicaid.
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