Ontario’s auditor general has raised serious concerns about how the province monitors physician billing practices, revealing that the current system fails to flag high risk or unusual claims. The findings, released Tuesday in Shelley Spence’s annual report, highlight long standing weaknesses in the Ministry of Health’s oversight tools and warn that millions of dollars may be at risk in a system that has not kept pace with modern technology. Spence said that stronger monitoring could potentially redirect funds toward hiring more family doctors, a critical need as Ontario struggles with widespread shortages.
The audit found repeated instances of physicians billing for more than twenty four hours of work in a single day, with as many as eighty two doctors doing so last year. More than one hundred doctors annually also submitted claims for every day of the year, and several billed for services to more than five hundred patients in a single day. While Spence acknowledged that some claims may have legitimate explanations, she stressed that the ministry has no automatic process to flag or review them. A post payment audit uncovered one case where a doctor received nearly one point four million dollars in overpayments while logging impossible hours.
Health Ministry officials defended the system, highlighting the complexity of the province’s five thousand billing codes and the overlap between some medical procedures. However, Spence noted that the ministry conducts audits only when prompted by complaints or tips, rather than using proactive data analysis. The audit division recovered eight point one million dollars between 2022 and 2025, but staffing levels have remained unchanged since 2017 despite repeated calls for expansion. Opposition parties criticized the lack of oversight, with NDP Leader Marit Stiles calling the findings unacceptable and urging the government to improve monitoring.
The report also uncovered major issues within Health Care Connect, the province’s system for linking patients with family doctors. Although the government has pledged to ensure every Ontarian has access to primary care by 2029, the audit shows that only a small portion of people who lack a family doctor are registered with the program. Of the more than one hundred ninety seven thousand people referred since 2020, half waited less than three weeks, but over one hundred thousand remained on the wait list for more than a year as of June. Only seven percent of physicians operating under a patient enrollment model accept patients through Health Care Connect, limiting its effectiveness.
The auditor general also found that the province’s plan to expand medical school seats was based on outdated and incomplete data. The government relied on an estimate suggesting one point three million Ontarians lacked primary care, but a more recent internal analysis conducted with researchers determined that the true number is closer to two million. Meeting that level of need would require roughly two thousand additional family doctors, far more than current training plans can supply. Spence said that without accurate data and stronger oversight, Ontario risks falling further behind in its efforts to expand access to primary care.
