Ontario auditor general finds province not properly overseeing doctor billings

TORONTO – Ontario’s auditor general has found that the province is not properly overseeing doctors’ billings, including in a few cases of physicians billing for more than 24 hours in a day or working 365 days in a year.

Shelley Spence made the findings in her annual report released Tuesday, which contains a series of health-related audits that also found very few family doctors are participating in the province’s Health Care Connect system – key to helping Ontario meet its goal of attaching everyone to primary care – and the government hasn’t adequately planned its medical school expansion.

As part of the health audits, Spence found that the Ministry of Health system that doctors use to bill OHIP for services provided to patients has limited ability to flag high-risk billings.

An analysis of claims over the last three years found that in each year at least 59 doctors billed for more than 24 hours of service in a day, Spence wrote, with a high of 82 doctors doing so in 2024/25.

The ministry hasn’t thoroughly reviewed those to determine reasons or if time-based fee codes need to be updated, and doesn’t use hourly billing data to select doctors to audit, she found.

“There may be valid reasons for billing a large number of hours a day; however, without flagging these instances for review, the ministry does not know if the billings are appropriate,” Spence wrote.

As well, more than 100 doctors in each of the last three years submitted claims for working all 365 or 366 days a year, which should have been flagged as high-risk, the auditor said. Numerous physicians also billed for services provided to more than 500 patients in a single day and were not subjected to post-payment audits, Spence found.

The ministry has conducted some post-payment audits on high-billing doctors, including one case that identified nearly $1.4 million in overpayment to a doctor billing more than 24 hours in a day 98 times over two years, including one day they billed 114 hours of services, the auditor wrote.

Identifying cases for ministry audit is largely done through tips and complaints, a reactive approach rather than a proactive one, Spence said. The ministry audits recovered $8.1 million between 2022 and 2025 but adding more staff to the audit division could increase that number, she said. The ministry asked the government in 2017 for more audit staff but the number remains the same at eight, Spence found.

The Ontario Medical Association and the Ministry of Health agreed in 2019 to reduce “medically unnecessary services” such as “low value” tests to save $480 million per year, but so far only $87 million of that has been realized, the auditor wrote.

The ministry has agreed with all of the auditor’s recommendations to improve the system.

When it comes to connecting patients to family doctors, a key goal of the government, the auditor said very few physicians are participating in the province’s Health Care Connect system, leading to long wait times.

The government has boasted of reducing the wait list by half, but the auditor said Tuesday that the number of people on that list is not representative of the true need for primary care, as only about 11 per cent of people without a family doctor have registered.

As well, the auditor found that the government’s plan to add 340 undergraduate and 551 postgraduate medical school seats with a focus on family medicine was based on an underestimate of how many people have no primary care provider.

This report by The Canadian Press was first published Dec. 2, 2025.