Premier Doug Ford’s government is ailing on health care by failing to get more Ontarians a family doctor, ensure prompt appointments and oversee OHIP billings, says the auditor general.
In her annual report to the legislature, watchdog Shelley Spence diagnosed a lack of effort to crack down on an estimated $1 billion in potential overcharges by physicians — including 59 who billed for more than 24 hours in a day.
And there was “limited oversight” that leads to Ontarians paying out-of-pocket for services insured by OHIP, particularly at cataract clinics.
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“The ministry (of health) has not done enough work to prevent these practices,” Spence wrote in the 483-page report released Tuesday.
Despite increasing spaces in medical schools to address a shortage of doctors, a lack of training sites such as primary care teaching clinics means the province is graduating 44 per cent fewer family physicians than forecast.
That’s because the Health Ministry led by Sylvia Jones “did not, in a timely manner, plan for the development of additional family physician training sites,” said the report by Spence, who in October made headlines by exposing problems with the government’s controversial $2.5 billion Skills Development Fund following a special investigation.
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The in-depth look at health care follows the government’s promise on the eve of the Feb. 27 election campaign to get every Ontarian a family doctor within four years — a pledge that helped neutralize the issue as Ford returned to power with a rare third majority.
“Our audit concluded that the ministry, in conjunction with Ontario Health, did not consistently have processes in place to plan and oversee programs and initiatives to improve patients’ access to primary care,” the report said.
“The ministry did not have effective processes to measure and report on whether primary care is accessible to patients and has no timeline on how it will collect this data.”
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While the government hired former federal Liberal health minister Dr. Jane Philpott to connect every resident to a family doctor by 2029 based on postal codes, the province is not doing enough to promote its “health care connect” service so that more Ontarians know to register.
Citing a 2023 study, Spence said only 35 per cent of provincial residents who have a family doctor can get same-day or next-day appointments, leading some to seek care at walk-in clinics or hospital emergency departments.
On overbilling, Spence blamed old technology for failing to flag suspiciously high payouts and patterns for a surprisingly small staff tasked with investigating.
“We conclude the ministry does not have effective systems and procedures in place to identify, review and prevent inappropriate physician billings. The ministry continues to use an outdated claims system that has limited functionality to automatically identify and prevent high-risk billings.”
The ministry of health, which by far accounts for the largest share of government spending, has just eight people auditing questionable billings — a number that has not changed since 2017. There are about 5,000 OHIP fee codes.
In 2024, the Health Ministry paid doctors $19.5 billion through OHIP, up from $11.9 billion nine years ago.
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Between May 2021 and April 2022, one unidentified physician billed more than 24 hours of services on 98 days. On one of those days, that doctor billed 114 hours of services. The ministry identified $1.4 million in overpayments and asked for the money back. It went to an appeal board and a hearing is scheduled for next May.
Another doctor who billed 24 hours of services on 15 days four years ago has agreed to repay $105,000 in “inappropriate” charges.
The auditor also found “patients are not always aware of what can and cannot be charged by a physician,” resulting in people paying out-of-pocket.
Ford and Jones have repeatedly said patients should pay “with their OHIP card, not their credit card” as the province expands more medical services to private clinics operating within the public system.
Cataract surgeries are a case in point.
“We noted cases where physicians charged patients directly for optional or unnecessary add-ons (for example, upgraded or enhanced eye lenses) without informing patients about their right to opt for a basic, free-of-charge cataract surgery entirely funded by OHIP.”
When opposition parties have raised complaint about this, Jones has urged people to contact the ministry. But the report stressed more preventative work by the ministry is needed, along with better consumer awareness.
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