00:00:00.000The Office of the Auditor General of Ontario just dropped a report recently that reads less
00:00:09.360like oversight and more like a warning flare. Doctors billing more than 24 hours in a single
00:00:15.200day. Physicians billing all 365 days of the year. A tiny group collecting millions annually with
00:00:21.760limited follow-up and weak enforcement behind the scenes. Now let's be clear, the vast majority of
00:00:27.360doctors in this province work hard and play by the rules. This is not an attack on frontline
00:00:32.040physicians. This is about a system that appears unable or unwilling to police itself. Because
00:00:38.140here's the real question. How does a private credit card company flag suspicious spending in seconds
00:00:43.140but our publicly funded health care system pays first and asks questions later? Why are recoveries
00:00:49.460partial? Why do reviews take years? And why does oversight rely on complaints instead of modern
00:00:55.340fraud detection tools? It isn't just about billing, it's about trust. And when families can't find a
00:01:01.500family doctor, when ERs are overflowing, and when taxpayers are told there's never enough money,
00:01:07.340we deserve to know every dollar is protected.
00:01:12.020We found that as of 2024, an estimated 2 million Ontarians, or about 12 percent of the population,
00:01:20.060did not have a primary care provider. Our audit found that the Ministry of Health and Ontario Health
00:01:26.300did not consistently have processes in place to plan or oversee programs and initiatives that are
00:01:32.620intended to improve patients' access to primary care providers. Our audit found that the province's
00:01:38.220centralized matching program, called Health Care Connect, has not kept up with demand. The number of
00:01:45.820Ontarians on the waitlist as of January 2025 represented only 11 percent of the estimated
00:01:52.060number of Ontarians in need of a family practitioner. On Health Care Connect, there were more than 108,000
00:01:59.500people waiting for more than a year to be matched with a doctor. We also noted that there was a failure
00:02:05.740to coordinate physician recruitment at the provincial level, which has resulted in a fragmented and
00:02:11.980competitive approach to recruitment across the province. We examined the government's oversight of
00:02:17.740physician billings. We found that the Ministry lacks a modernized payment system and is not using data
00:02:24.220analytics to detect potentially inappropriate physician billing. The Ministry of Health paid $19.5 billion
00:02:33.180to roughly 35,000 physicians in 2024-25 through the Ontario Health Insurance Plan, or OHIP system.
00:02:41.820The OHIP system, which has been in use since the 80s, cannot automatically flag potentially abnormal
00:02:48.540billings for further investigation. We found that a system modernization initiative announced in 2023
00:02:55.580has been delayed and is awaiting approval by the government. We observed that the Ministry relies
00:03:02.140primarily on tips and complaints to trigger post-payment audits. We observed that only eight staff conduct
00:03:09.820post-payment audits the same number as they did in 2017. In a 2024 analysis, the Ministry of Health noted
00:03:18.380that between three to five percent of fee-for-service claims that they reviewed had potential anonymies.
00:03:24.380We calculated, using their percentage and the $13.3 billion in fee-for-service payments made last year, that approximately $400 to $665 million could have these potential anomalies.
00:03:40.380Our analysis of fee-for-service billing data between 2021 and 2024 found numerous examples of potentially
00:03:48.940high-risk billings that were not audited by the Ministry. This included physicians billing more than
00:03:54.70024 hours a day over 365 days in a year, billing for seeing more than 100 patients in a day, and where
00:04:03.180their overall billing was significantly higher than their peers. We recommended that the Ministry utilize
00:04:09.900data analytic tools to flag these and other high-risk payments for review.
00:04:15.020The Ministry of Health agreed with all 19 of our recommendations.