Auditor-General Shelley Spence following the release of her annual report at the Ontario legislature in Toronto on Tuesday.Sammy Kogan/The Canadian Press
Ontario’s Auditor-General says the province isn’t auditing doctors whose billings raise obvious red flags, including 82 doctors who claimed to have worked 24 hours or more in a single day, a diagnostic radiologist who billed for an average of 461 patients daily and an ophthalmologist who billed $6.7-million in one year, more than twice as much as the next highest biller in the specialty.
The same unnamed ophthalmologist has been investigated three times for allegedly charging patients out-of-pocket fees for services that should be free through the Ontario Health Insurance Plan.
The first review found the doctor wrongly charged patients, a second cleared the ophthalmologist, and a third is ongoing.
In an annual report released Tuesday, Ontario Auditor-General Shelley Spence said potential waste in the billing system could be money used to “hire more family physicians.”
Health care was a major focus of Ms. Spence’s report. Along with scrutinizing physician billings, the Auditor-General investigated the Progressive Conservative government’s oversight of primary care and of medical education in family medicine.
Her office found shortcomings in both areas that could prevent Premier Doug Ford from keeping his promise that every Ontarian will have a primary-care doctor or nurse practitioner by 2029.
However, Jackson Jacobs, a spokesperson for Ontario Health Minister Sylvia Jones, said the report doesn’t account for the government’s $2.1-billion plan to transform primary care, aspects of which rolled out after the auditors completed their work.
On the physician billing front, Ms. Spence criticized the government for being slow to modernize its antiquated OHIP system and for failing to assign more staff to audit suspicious billings. Only eight people are dedicated to that task, she said, the same number as when her office flagged the problem in a 2016 audit.
The Ministry of Health disputed that figure and said there are 130 staff reviewing OHIP billing claims as part of a manual review.
The audit provided examples of unnamed doctors whose billing history seemed suspicious in multiple ways. Some claimed to work around the clock nearly every day of the year, charging the government millions more than was typical for their area of medicine.
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“Those were all very shocking to me,” Ms. Spence told a news conference.
One diagnostic radiologist billed $7.6-million over three years during which he or she claimed to have worked 364 or more days every year. The radiologist claimed to have served 728 patients on one day in the fiscal year 2023-2024, likely through interpreting imaging scans.
Mr. Jacobs from Minister Jones’s office said the most serious cases identified by the Auditor-General are already being reviewed.
“Where wrongdoing is confirmed, the ministry will take all appropriate recovery and accountability actions,” he said in a statement.
Zainab Abdurrahman, president of the Ontario Medical Association, said the audit underscores complaints doctors have been making for years about OHIP’s more than 5,000 billing codes, some of them decades old.
The OHIP billing system is “inconsistent and really unable to distinguish complex, legitimate care from potential inappropriate billing,” she said. “The vast majority of physicians bill accurately and in good faith.”
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In a separate audit of oversight of primary care, Ms. Spence concluded that the province’s Health Care Connect service, which is supposed to match patients in need with available doctors, has in recent years left patients languishing in the queue for too long.
Of the approximately 178,000 people who registered with Health Care Connect between 2020-2021 and 2024-2025 and who were still waiting to be referred to a physician as of June, more than 108,000 had been waiting for more than a year.
Mr. Ford appointed former federal health minister Jane Philpott last year to lead a primary care action team dedicated to attaching every Ontarian to primary health care.
Her team has in the past year made a major effort to tackle the Health Care Connect waiting list, which Mr. Jacobs said isn’t accounted for in the report. The team has now cleared 65 per cent of the approximately 235,000 names that were on the list as of Jan. 1, according to the minister’s office.
Ontario NDP Leader Marit Stiles said the audit showed the government’s plan to connect people with family doctors was a failure.
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“Lots and lots of announcements. Lots of fluff. Lots of blowing smoke. But actually very little in the way of actual action,” she told reporters at Queen’s Park.
In another health-related audit, Ms. Spence and her team found the government failed to heed warnings that there were not enough family medicine clinics in the province with the capacity to teach medical residents.
For that reason, by the end of this academic year, the Ministry of Health will have rolled out 44 per cent fewer family medicine seats than originally planned, according to the audit.
With reports from Jeff Gray and Laura Stone