Ontario’s oversight of doctors’ billings has been criticized by the auditor general for lacking proper monitoring, with instances of physicians billing for more than 24 hours in a day. This has raised concerns about potential misuse of funds that could otherwise be allocated to increasing the number of family doctors in the province. The annual report released by Shelley Spence highlighted several health-related audits, revealing low participation 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 of medical school expansion was deemed inadequate.
During the health audits, it was discovered that the Ministry of Health’s billing system for doctors, in place since the 1980s, does not have the capability to automatically identify high-risk billings despite advancements in technology over the years. The auditor general emphasized the need for a review of the billing system to potentially recover funds that could be redirected to hiring more family physicians. Analysis of claims from the past three years revealed instances where at least 59 doctors billed for more than 24 hours in a day annually, with a peak of 82 doctors in 2024-25.
Furthermore, multiple doctors were found to have submitted claims for working every day of the year, with some billing for services provided to over 500 patients in a single day. The Ministry of Health was criticized for not proactively reviewing such cases or utilizing hourly billing data to select doctors for audits. Despite conducting some post-payment audits on high-billing doctors, including identifying significant overpayments to one doctor, the ministry’s audit division remains understaffed.
The auditor general highlighted the need for a more proactive approach to identifying cases for audit, as the current system relies heavily on tips and complaints. While some cost recoveries have been made through audits, increasing the audit division’s staff could lead to higher financial savings. The Auditor also pointed out a shortfall in realizing cost savings from reducing “medically unnecessary services.” The Health Care Connect system, aimed at connecting residents with primary care providers, was found to have long wait times and limited effectiveness.
The government’s commitment to ensuring access to primary care for all Ontarians by 2029 was questioned, with concerns raised over the inefficiencies of the Health Care Connect system. Although progress has been made in reducing the wait list, the auditor emphasized that the number of people waiting for primary care does not accurately reflect the true demand. Additionally, the government’s strategy to increase medical school seats focused on family medicine was criticized for underestimating the number of individuals without a primary care provider in the province.
In response to the findings, Health Minister Sylvia Jones’ office stated that they are investigating the cases raised by the auditor and will take appropriate action if wrongdoing is confirmed. Opposition Leader Marit Stiles criticized the lack of oversight and monitoring by the government, emphasizing the need for better regulation in the healthcare billing system.