A recent report by the auditor general has highlighted concerns about the oversight of doctors’ billings in Ontario, revealing instances where physicians billed for more than 24 hours in a day. This mismanagement of funds could potentially hinder efforts to recruit additional family doctors in the province. The report also shed light on the low participation of family doctors in Ontario’s Health Care Connect system, a crucial program aimed at ensuring everyone has access to primary care. Additionally, the government’s lack of strategic planning for medical school expansion was brought into question.
The audit uncovered that the Ministry of Health’s billing system, established in the 1980s, lacks the capability to automatically identify high-risk billings, despite advancements in technology over the past decade. The auditor general emphasized the need for a comprehensive review of the billing system to potentially recover funds that could be redirected to hiring more family physicians. Analysis of claims over the past three years revealed instances where doctors billed for more than 24 hours in a day, with a peak of 82 doctors doing so in 2024-25. However, the ministry has not thoroughly investigated these cases to determine their validity or the necessity to update fee codes.
Moreover, the report highlighted alarming practices by some doctors, such as submitting claims for working every day of the year and providing services to over 500 patients in a single day. Despite these red flags, post-payment audits were not consistently conducted on these high-billing doctors. The report referenced a case where an overpayment of nearly $1.4 million was identified for a doctor billing excessively over a two-year period.
In response to the report, Health Minister Sylvia Jones was unavailable for comment, while her parliamentary assistant defended the complexity of the billing system. The auditor general criticized the reactive nature of identifying cases for ministry audits, stressing the need for a more proactive approach. Although some progress has been made through post-payment audits, the report suggested that increasing staff in the audit division could further enhance recovery efforts.
The report also raised concerns about the effectiveness of the Health Care Connect system in connecting Ontarians to primary care. Despite government efforts to reduce wait times, a significant number of individuals remain on the waitlist for extended periods. The auditor general highlighted discrepancies in the number of individuals on the waitlist compared to the actual need for primary care services. Additionally, the report criticized the government’s inadequate promotion of Health Care Connect and underscored the need for more family doctors to address the unmet demand for primary care in Ontario.
