Ontario’s oversight of doctors’ billings is lacking, as revealed by the auditor general, who highlighted instances of physicians billing for over 24 hours in a day. This mismanagement of funds could otherwise be allocated towards increasing the number of family doctors in the province. Shelley Spence presented these findings in her annual report, which also included audits in the healthcare sector. The report noted a low participation rate of family doctors in Ontario’s Health Care Connect system, which is crucial for achieving the goal of providing primary care to all residents. Additionally, the government’s planning for the expansion of medical schools was found to be inadequate.
Spence’s health audits uncovered deficiencies in the Ministry of Health’s billing system for doctors, which has not been updated to automatically detect potentially fraudulent billings. Despite advancements in technology over the past decade, the system still lacks the capability to flag high-risk billings. Spence emphasized the need for a review of the billing system to ensure appropriate use of funds, potentially enabling the hiring of more family physicians. An analysis of claims over the last three years revealed instances where doctors billed for more than 24 hours in a day, with some even claiming to have worked all 365 or 366 days in a year. The ministry has not thoroughly reviewed these cases to determine their validity or the need for updates to fee codes.
The auditor general highlighted concerns regarding the lack of proactive measures in identifying billing anomalies, as cases for ministry audits are primarily identified through tips and complaints. While post-payment audits have recovered $8.1 million between 2022 and 2025, Spence suggested that increasing staff in the audit division could yield higher recoveries. The audit also revealed a discrepancy in the reduction of “medically unnecessary services,” with only a fraction of the targeted savings realized so far.
In terms of the Health Care Connect system, the auditor noted its ineffectiveness in connecting Ontarians to primary care in a timely manner, leading to long wait times for many individuals. Despite government claims of reducing the wait list, the auditor emphasized that the current numbers do not accurately reflect the true demand for primary care. The government’s plan to expand medical school seats based on outdated estimates of unattached individuals was also flagged as a concern, with the auditor recommending a reassessment based on more recent data.
While the government defends the complexity of the billing system, the auditor general’s report underscores the need for improved oversight and proactive measures to ensure the efficient allocation of resources and better access to primary care for residents.
