Tough-talking audit, alleged Medicaid fraud in NC: deja vu all over again

Posted on by

A bit of a tizzy has arisen over state auditor Dave Boliek’s recent speech to an auditor’s conference:

As fraud concerns ramp up across the country, particularly involving Medicaid, North Carolina State Auditor Dave Boliek told Fox News Digital 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 noting in an interview with Fox News Digital a 47,000% explosion in autism therapy billings 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 and are in the middle of that.“

Boliek, who was speaking to Fox News Digital at the annual State Financial Officers Foundation 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.”

One of the core problems, Boliek explained, is 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 autism therapy.

[…]

Shocking stuff, eh?

Actually, no.  We’ve heard all this before and seen little actually being done about it.

Before you print up those “Boliek for Governor” campaign signs and buttons, consider the fact that then-Gov. Pat McCrory (R) and then-auditor Beth Wood (D) sounded a very similar alarm WAY BACK in 2013:

Gov. Pat McCrory is getting kudos among the general populace for his tough comments on the state Medicaid program at a Thursday press conference.  Auditor Beth Wood is also getting a tip of the hat for a tough audit that found tons and tons of waste fraud and abuse.  But there were a few things that came up during their joint presser on Thursday that got my spidey-sense tingling. First:

[…] In one example of bad budgeting, the state Medicaid office withheld $131 million that was owed to the federal government, though the legislature disallowed the practice and the Office of State Budget and Management warned the Medicaid office not to hold onto the money. The audit says the Medicaid chief business operations officer told auditors that “legislative leadership” knew the Medicaid office withheld the money, so department officials thought it was OK. The audit did not refer to the business officer, Steve Owen, by name, and did not identify the legislative leaders who knew. […]

SCREEEEEEEEECCCCCCHHHH !!!!   So, we have an insinuation in the audit that “legislative leadership” may have violated the law.  Names?  If we’re going through with this transparent, good government thing, we need to lay all of the cards on the table.  Surely, it couldn’t have been US Senator-in-waiting Thom Tillis.   Somebody in authority needs to get to the bottom of THIS.  
And, the second item:
[…]“This audit should be a concern for every North Carolinian,” said Governor McCrory. “Every dollar that is mismanaged at the Department of Health and Human Services for Medicaid is one dollar less that is available for medical services, education or road and bridge repair.”  […]
Thirteen years later and we STILL don’t know the names of the ‘legislative leaders’ cited in the audit.  Thirteen years later and we STILL don’t know if any of the stuff cited in this audit got fixed.   This happened back when the NCGOP controlled the executive AND legislative branches of state government.
Medicaid – with all of these alleged fraud and mismanagement allegations –  got expanded TWICE since then with a lot of GOP help. (Roy Cooper is more than happy to tell you all about that.) 
So, at least two times in thirteen years, we’ve had a tough-talking audit of the Medicaid program and  a lot of outrage over allegations of fraud and mismanagement.  But what, if anything, got done to fix the problem?  What, if anything, is being done to address what Boliek is talking about today?