Ontario’s oversight of doctors’ billings has been flagged for deficiencies by the auditor general, potentially diverting funds that could otherwise support the recruitment of more family physicians. Shelley Spence outlined these concerns in her recent annual report, emphasizing issues such as limited engagement of family doctors in the Health Care Connect system and inadequate planning for medical school expansion by the government.
Within the health audits conducted, Spence highlighted gaps in the Ministry of Health’s billing system, which lacks automated detection of high-risk billings despite advancements in technology over the past decade. This raises concerns about the potential for billing system inefficiencies and the need to review and potentially recover funds to enhance family physician recruitment efforts.
Analysis of billing claims over the past three years revealed instances where at least 59 doctors billed for more than 24 hours in a day annually, with a peak of 82 doctors in the 2024-25 period. The ministry’s failure to thoroughly investigate these cases or update fee codes based on hourly billing data was also noted by Spence, who stressed the importance of flagging and reviewing such billings for appropriateness.
Highlighting extreme cases, Spence pointed out that over 100 doctors per year billed for working every day of the year, while some billed for services to over 500 patients in a single day without post-payment audits. Despite some post-payment audits uncovering significant overpayments, Health Minister Sylvia Jones was not available for immediate comments, and her parliamentary assistant, Anthony Leardi, defended the billing system’s complexity at a press conference.
Spence criticized the reactive nature of identifying cases for ministry audits, emphasizing the need for more proactive measures and additional staff in the audit division to enhance recovery efforts. The audit also revealed discrepancies in achieving cost-saving targets related to reducing medically unnecessary services.
Regarding the Health Care Connect system, the auditor noted challenges in effectively connecting Ontarians to primary care, resulting in prolonged wait times for many individuals. While progress has been made in reducing the waitlist, Spence highlighted discrepancies in the representation of true primary care needs and the limited acceptance of patients by doctors through the system.
Additionally, the government’s medical school expansion plans focused on family medicine were questioned for underestimating the demand for primary care providers. A revised estimate indicated a higher number of unattached Ontarians, necessitating a larger influx of family doctors to address the healthcare gap effectively.