Medicaid fraud fears grow amid massive red state billing spike in sector that also plagued Minnesota

Medicaid fraud fears grow amid massive red state billing spike in sector that also plagued Minnesota

Dave Boliek says his office is working 'hand-in-hand' with JD Vance's focus on eliminating waste and abuse

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Red state auditor reveals massive fraud concern ‘built in by government’

Fox News Digital spoke to North Carolina State Auditor Dave Boliek about how Medicaid payouts have ballooned in his state and what he’s trying to do about it.

As fraud concerns ramp up across the country, particularly involving Medicaid, North Carolina State Auditor Dave Boliek tells Fox News Digital that the problem is very real in his state, especially when it comes to autism therapy, an area that has been highly scrutinized in Minnesota.

Boliek is sounding the alarm on potential waste, fraud, and abuse within the state’s Medicaid program, specifically calling out in an interview with Fox News Digital a 47,000% explosion in autism therapy billings that he has flagged since taking office last year.

"Those are vital services to folks and individuals that need that therapy," Boliek said. "But when you have, like in North Carolina, a system that went from $1.4 million or so in total billings for autism therapy to more than $660 million a year in billings on autism therapy within a five-year range, that begs an audit from the state auditor, who in North Carolina, we are the top watchdog agency for taxpayer waste, fraud, and abuse prevention. So we've dug down into that or in the middle of that."

Boliek, who was speaking to Fox News Digital from the State Financial Officers Foundation annual conference in Orlando, says his office is "hand-in-hand" with Vice President JD Vance’s focus on eliminating waste, fraud, and abuse to "make sure that the people who need the services and deserve those services get the services" without "wasting money."

NORTH CAROLINA AUDITOR EXCITED FOR 'REAL EFFECT' OF STATE-LEVEL DOGE: 'KEEPING GOVERNMENT ACCOUNTABLE'

North Carolina state auditor Dave Boliek gives a report during the Council of State meeting in Raleigh, N.C., on Feb. 4, 2025. (Getty Images)

One of the core problems, Boliek explained, is that the system is oftentimes designed in a way that fails to properly safeguard against waste and abuse.

"What we’ve got is we’ve seen examples where there might be three different clinical providers billing during the same tranche of time on an autism therapy client and that is because of poor rulemaking," Boliek explained. "Some of it is possibly illegal and probably illegal, and we’re going to point that out, and we’re going to try to put people in cuffs because of it."

"But some of it might be technically legal because of the lax oversight from a Democrat-led Department of Health and Human Services," Boliek said, referencing the top state health agency in North Carolina.

In a March 10, 2026, hearing of the Joint Legislative Oversight Committee on Medicaid, the North Carolina Department of Health and Human Services presented data that matches Boliek's narrative of exponential growth in the autism therapy space.

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Vice President Vance and CMS Administrator Dr. Oz tackle fraud in areas such as Medicaid, hospices, and durable medical equipment suppliers. (Oliver Contreras/AFP via Getty Images)

The report confirmed that Medicaid spending on ABA (Applied Behavior Analysis) therapy grew by 347% between 2022 and 2025 alone and that total spending is projected to hit $842 million in state fiscal year 2026 and $1.14 billion by state fiscal year 2027.

Medicaid fraud has been a hot-button issue across the United States when a scandal in Minnesota gained widespread attention last fall and spreading to places like California and Ohio, the latter being the subject of a recent Daily Wire exposé examining seven medical buildings in Columbus, Ohio, that house 288 Medicaid companies and bill the government $250 million.

The key issues with Medicaid and the ease with which it can be abused both illegally and legally, according to Boliek, are the "minutia of rulemaking" that is "built in by government."

"For example, how individual entities, whether they are a provider of clinical medical services or whether they're a provider of daycare services or other services that can be paid for through departments of Health and Human Services, how those rules are set up and what the billing rules are," Boliek explained.

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"It really is minutiae, but in North Carolina, for example, we still have some services that are delivered on a fee-for-service basis, and they lack transparency and lack accountability with respect to who can bill and how much can be billed for particular services. That's why we've taken a deep dive into some particular fee-for-service areas in North Carolina and are looking at provider data on exactly how those services are billed. That's where the flaws are."

During the developing fraud scandal in Minnesota, federal agents discovered that one suspected scammer defrauded the state’s autism-treatment program of roughly $14 million and allegedly billed Medicaid for fake therapy sessions, used untrained staff and paid parents $300 to $1,500 a month to keep their kids in the program.

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

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Minnesota Gov. Tim Walz announced he will not seek reelection during a press conference at the State Capitol in St. Paul on Jan. 5, 2026. Walz said he concluded he cannot fully commit to a political campaign and did not take questions from reporters. His announcement comes amid a major social services fraud scandal in the state. (Jerry Holt/The Minnesota Star Tribune via Getty Images)

"The fraud is so obvious, just simply looking at the exponential growth in some of these social services programs, that anybody kind of looking at how fast this was growing should have known that a fraud was a major reason why," Minnesota state Sen. Michael Kreun, a Republican, told Fox News Digital in December about social services fraud in his state.

In terms of next steps in North Carolina, Boliek says his office is working with lawmakers to strengthen fraud enforcement by increasing financial accountability, expanding investigative and Medicaid audit resources and investing in staff and technology to recover misused funds.

Boliek explained that one important tool to crack down on fraud is artificial intelligence.

"Look, we've got to pour jet fuel on artificial intelligence in the area of state auditing because the fraudsters are using AI and if we're not using AI to combat the fraud, then we're going to be on our heels and the taxpayer isn't going to be protected."

He emphasized that these steps, especially enhancing oversight of programs like Medicaid, are aimed at holding individuals accountable and returning taxpayer dollars for more effective use.

The State Financial Officers Foundation, a group of financial officers that collectively oversees more than $3 trillion in state funds, released a report earlier this year outlining how the organization safeguarded more than $28 billion of waste, fraud, and abuse in 2025 alone.

"Every wasted dollar is a dollar that can't be spent on a person who actually needs service," Boliek said.

Andrew Mark Miller is a reporter at Fox News. Find him on Twitter @andymarkmiller and email tips to AndrewMark.Miller@Fox.com.

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