TORONTO — Ontario's auditor general has reported significant shortcomings in the province's oversight of doctors' billings. In her annual report released on Tuesday, Shelley Spence highlighted alarming instances where some physicians billed for more than 24 hours of service in a single day or claimed to work all 365 days of the year.

The report includes a series of health-related audits that reveal a lack of participation among family doctors in the province's Health Care Connect system. This system is crucial for Ontario's goal of ensuring that every resident has access to primary care. Additionally, the report indicates that the government has not effectively planned for the expansion of medical school seats.

Spence's findings show that the Ministry of Health's billing system for the Ontario Health Insurance Plan (OHIP) has limited capabilities to identify high-risk billing practices. Over the past three years, at least 59 doctors each year billed for more than 24 hours of service in a day, with a peak of 82 doctors doing so in the 2024-25 period. The ministry has not conducted thorough reviews of these cases to determine their validity or whether billing codes need updating.

"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 stated in her report.

The report also noted that more than 100 doctors submitted claims for working all 365 or 366 days in a year, which should have raised red flags. Furthermore, numerous physicians billed for services rendered to over 500 patients in a single day without undergoing post-payment audits.

In one notable case, a post-payment audit revealed nearly $1.4 million in overpayments to a doctor who billed for more than 24 hours on 98 occasions over two years, including one day where they claimed 114 hours of service. Spence criticized the ministry's approach to identifying cases for audit, stating it relies heavily on tips and complaints, making it reactive rather than proactive.

Between 2022 and 2025, the ministry's audits recovered $8.1 million, but Spence suggested that increasing staff in the audit division could enhance recovery efforts. Despite a request for more audit personnel in 2017, the number of staff remains at eight.

In 2019, the Ontario Medical Association and the Ministry of Health agreed to reduce "medically unnecessary services" to save $480 million annually. However, only $87 million in savings has been realized so far, according to the auditor.

The auditor general also pointed out that long wait times for primary care persist. While the government claims to have halved the waitlist, Spence noted that the number of individuals on the list does not accurately reflect the actual need for primary care, as only about 11 percent of those without a family doctor have registered.

Additionally, the government's plan to add 340 undergraduate and 551 postgraduate medical school seats, focusing on family medicine, was based on an underestimation of the number of people lacking a primary care provider. The Ministry of Health has agreed to all of the auditor's recommendations aimed at improving the system.