Autism Therapy Billing Hit $5.15 Billion. One State Audit Found a 47,000% Spike — and No One Had Explained It.
Applied behavior analysis therapy for autism is a real, evidence-based treatment covered by Medicaid in every state. Nationally, billing for it has grown into a $5.15 billion program since 2018 — and grown so fast, in at least one state, that the state’s own auditor called it a five-year oversight failure serious enough to draw a federal review.
Two states are now running the response in opposite directions: Florida has clawed back $136 million and blocked more than 3,200 providers under a new integrity initiative; North Carolina is still trying to explain a five-year billing spike its own Republican auditor blames on “lax oversight” from a Democrat-led state health agency.
- $5.15B national Medicaid spending on ABA autism therapy, 2018–2024 — Fox News, federal billing-code data
- 47,000% North Carolina's ABA billing spike over five years — from $1.4 million to $660 million a year — per State Auditor Dave Boliek — Fox News
- $136M Florida's Medicaid fraud/abuse clawback over the past two years; 3,200+ providers booted or blocked — Gov. DeSantis's office
National Medicaid spending on applied behavior analysis — the standard, clinically supported therapy for autism — totaled roughly $5.15 billion between 2018 and 2024, per federal billing-code data reviewed by Fox News. Three of the largest ABA providers nationally collected a combined $685 million of that over the same period; their identities weren’t disclosed in the reporting reviewed for this story, and this outlet was unable to independently confirm them before publication.
CMS’s own statement on the growth is carefully hedged: “While access to medically necessary services remains a priority, rapid program growth also underscores the importance of ensuring services are clinically appropriate, delivered by qualified providers, and supported by strong program integrity safeguards.” That is a federal regulator's way of saying the growth has outpaced the ability to verify it.
The starkest single data point belongs to North Carolina. State Auditor Dave Boliek (R), elected in 2024, found the state’s ABA billing rose from roughly $1.4 million to $660 million a year over five years — a 47,000% increase. Boliek attributed the spike to “poor rulemaking” and “lax oversight from a Democrat-led Department of Health and Human Services.” No indictments have been announced in North Carolina; this is an audit finding, not a criminal case, and should be read as an open question about oversight, not a proven fraud scheme.
North Carolina’s DHHS operated under Democratic governors through nearly the entire audited window; Gov. Josh Stein (D) took office in January 2025, near the tail end of it. Boliek has said his office is now working with the Trump administration’s anti-fraud task force, chaired by Vice President JD Vance (R), on next steps.
Florida built its response before the national numbers made headlines. Gov. Ron DeSantis (R) announced a Medicaid Integrity Initiative on June 12, 2026 in West Palm Beach: $72 million recovered in improper payments over the prior year, $136 million clawed back over two years, more than 3,200 providers terminated or blocked from the program, mandatory provider revalidation, and a pilot identity-verification partnership with SentiLink to catch fraudulent enrollments before they’re paid.
The initiative isn’t autism-specific — it covers Medicaid fraud broadly — but ABA billing is squarely inside its scope given the national growth curve. Unlike North Carolina’s open audit question, Florida’s numbers are administrative recoveries and program terminations, not criminal convictions; providers removed from the program haven’t necessarily been charged with a crime.
Not every state response is about catching bad actors. Georgia’s Medicaid managed-care plan CareSource cut its ABA reimbursement rate by 20%, effective May 11, 2026 — a straightforward payer response to rising costs, not an allegation against any provider. It belongs in the same national trend line as North Carolina and Florida, but it’s a program-cost story, not a fraud story, and shouldn’t be conflated with either.
Confirmed, national: $5.15B in ABA Medicaid spending, 2018–2024; CMS itself flags the growth as an oversight concern.
Confirmed, Florida: $136M clawed back, 3,200+ providers terminated — administrative action, not criminal charges.
Open, North Carolina: a 47,000% billing spike flagged by the state auditor — an audit finding under investigation, not an indictment.
Not fraud: Georgia's CareSource rate cut is a cost-control decision, not an allegation.
A real therapy, a real need, and a $5.15 billion national bill that grew faster than any single state’s ability to verify it. Florida chose enforcement and can point to $136 million in receipts. North Carolina is still explaining a 47,000% spike its own auditor can’t attribute to anything but oversight failure. Both started from the same national number.
