Ontario Oversight Lapses Let Physicians Bill for More Than 24 Hours a Day: Auditor General

Ontario's auditor general Shelley Spence speaks to media following the release of her annual report at the Ontario legislature in Toronto on Dec. 2, 2025. The Canadian Press/Sammy Kogan

Ontario’s auditor general says the province is not properly monitoring the billing practices of doctors, noting several cases in which physicians have billed for more than 24 hours in one day or for all 365 days of the year.

Provincial auditor Shelley Spence presented the findings in an annual report, which found that the Ministry of Health system that doctors are using to bill the Ontario Health Insurance Plan for services provided to patients has limited functionality for flagging high-risk submissions.

She outlined the problems she identified in an Oversight of Physician Billing audit, which was one of six performance audits published in the comprehensive report on Dec. 2.

The audit found that at least 59 doctors billed for more than 24 hours of service in a day in each of the past three years, reaching a peak of 82 physicians in the 2024–25 period.

The ministry has not conducted a comprehensive review to assess if time-based fee codes need revisions, and it does not rely on hourly billing data to select doctors for audits, the auditor general said.

“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, noting that the current system used by the province automatically pays most claims.

Spence pointed out several examples of billings that should have been flagged by the ministry’s system.

One featured a diagnostic radiologist who reported working 364 or more days in each year from fiscal 2021–2022 through 2023–2024, billing $3 million in the year 2023–2024 alone. Another highlighted an ophthalmologist who billed $6.7 million in a single year, more than twice that of the next highest biller in the field.

Spence also pointed out that more than 100 doctors in each of the last three years submitted claims for working all 365 or even 366 days a year, and numerous physicians also billed for services provided to more than 500 patients in a single day.

None of these cases were flagged as high risk or were subjected to post-payment audits, she said.

The ministry has conducted some post-payment audits on doctors with high billing practices, one of which uncovered almost $1.4 million in overpayments to a doctor who billed for more than 24 hours in a day 98 times within two years, including a day where the physician billed for 114 hours of services, the report said.

The identification of cases for ministry audits primarily relies on tips and complaints, indicating a reactive rather than proactive strategy, Spence said. The ministry’s audits yielded $8.1 million in recovered payments from 2022 to 2025; however, she noted that increasing the audit division’s staff could potentially boost that figure. The ministry requested additional audit personnel from the government in 2017, yet the total has remained unchanged at eight.

The report noted that the ministry paid physicians $19.5 billion through the Ontario Health Insurance Plan in 2024–2025, a 28 percent increase since the previous audit in 2015–2016.

Doctor Shortage and Wait Times

Spence not only scrutinized physician billings but also explored the provincial government’s regulation of primary care.

Premier Doug Ford’s government pledged $1.8 billion in January to connect an additional 2 million people to a publicly funded family doctor or primary care team within the next four years. Ford also appointed former federal Liberal Health Minister Jane Philpott to lead Ontario’s Primary Care Action Team, which is tasked with building a primary care system to create and expand 305 additional family health teams made up of a family physician or nurse practitioner as well as nurses, physician assistants, social workers, and dietitians.

The goal is to connect 300,000 more people to primary care this year, the province said in a press release at the time. Another 500,000 will be linked with a team the following year, and more than 600,000 are to be added annually in the subsequent two years.

The report from the auditor general, citing a network of primary-care researchers known as INSPIRE-PHC, indicates that approximately 2 million Ontarians were without a family doctor as of March 2024, rising from 1.8 million in 2020.

The report also found that a limited number of family physicians are participating in the province’s Health Care Connect system, which plays a crucial role in helping Ontario fulfill its aim of connecting all residents to primary care. She said just 7 percent of family physicians operating under a payment model that requires them to formally enrol patients were prepared to accept patients from the Health Care Connect waiting list.

The report indicated that among the approximately 178,000 individuals who registered with Health Care Connect from 2020–2021 to 2024–2025 and were still awaiting a referral to a physician as of June, more than 108,000 had been on the list for more than a year.

Ontario Health Minister Sylvia Jones said this fall that Philpott’s team has made a concerted effort to tackle the Health Care Connect waiting list over the past year. Her office reported the Primary Care Action Team was halfway to its goal of clearing the approximately 235,000 names on the provincial waiting list as of Jan. 1, 2025, by the following spring.

Medical Schools

Spence also examined in a separate audit the province’s plan to expand medical school seats for future family doctors. The plan included opening two new medical schools at Toronto Metropolitan and York universities.

The auditor general found that the government’s plan to introduce 340 additional undergraduate and 551 postgraduate medical school seats, concentrating on family medicine, was based on a miscalculation regarding the number of people who do not have a primary care provider.

Spence said the province ignored warnings from the heads of existing medical schools regarding the insufficient number of family medicine clinics available to train medical residents.

Consequently, the Ministry of Health will have implemented 44 percent fewer family medicine positions by the conclusion of this academic year than initially intended.

Spence and her team laid out recommendations in conjunction with each of the audits, all of which were accepted by the Ministry of Health.

The Canadian Press contributed to this report.