Guilford County report raises Medicaid fraud questions in autism services

Guilford County families looking for autism therapy through Medicaid are watching a fast-growing billing crisis with real local consequences. As state auditors and enforcement officials dig into applied behavior analysis claims, parents face a harder question than fraud alone: who will protect access to care if the rules tighten and providers start pulling back?

North Carolina’s Medicaid billings for ABA therapy climbed from about $6 million in 2021 to about $660 million in 2025, a jump state Auditor Dave Boliek described as roughly 11,000% in four years. NC DHHS-related reporting said total Medicaid and federal spending on ABA in the state topped $505 million in 2025, up from about $1.9 million five years earlier.

The number of people receiving ABA also rose sharply, from 8,704 beneficiaries in 2024 to 13,447 in 2025. State officials have said the spending growth far outpaced the increase in autism diagnoses and could not be explained by access alone, a warning sign that has pushed autism-therapy billing into the center of a broader Medicaid scrutiny effort.

In North Carolina, the Medicaid Investigations Division is the main state unit charged with investigating fraud and abuse by health care companies and providers. The North Carolina Department of Justice says its Medicaid fraud work has recovered more than $1 billion in restitution and penalties, showing that billing enforcement is not new, even if the current scale of ABA spending is.

Guilford County has already seen that enforcement reach close to home. On May 5, 2026, Attorney General Jeff Jackson announced a $584,143 settlement with Crossroads Treatment Center of Greensboro, P.C., resolving allegations that the provider submitted false claims to Medicaid. The case, handled by the state and the U.S. Attorney’s Office for the Middle District of North Carolina, offered a local example of how billing disputes can become legal and financial consequences.

For families, the stakes are immediate. Lovely Day ABA and Autism Services in Greensboro shut down in May 2026 after an insurance billing dispute, leaving about 100 local families searching for new therapy slots and coverage. In a county where families already struggle to find timely autism services, even well-founded fraud enforcement can ripple outward, reducing the number of providers willing to accept Medicaid or adding more paperwork to already stretched clinics.

North Carolina House Republicans have called on Jackson and the DHHS secretary to testify about fraud, waste and abuse, underscoring how the issue has moved beyond one billing category. In Guilford County, the question is whether oversight can catch questionable claims without shutting vulnerable children out of the services their families depend on.