Ontario audit finds major gaps in billing oversight, primary care access, medical school planning and PPE tracking, raising concerns about system reliability.

Ontario Audit Exposes Major Weaknesses in Health Oversight

Billing Oversight Under Investigation

Ontario’s government says all questionable OHIP billing cases flagged by Auditor General Shelley Spence are now being reviewed. A spokesperson for Premier Doug Ford’s office confirmed investigations are underway following the release of Spence’s annual report on Tuesday at the Ontario Legislature.

Opposition Leader Marit Stiles argued the issue points to a long-standing lack of government oversight rather than misconduct by physicians. She criticized the province for assigning only eight staff to monitor potential OHIP overbilling, calling the situation “bananas” and warning it reflects a broader trend toward privatization in Ontario’s healthcare system.

Primary Care Access Still Falling Short

Spence’s report found major shortcomings in the province’s approach to connecting residents with family doctors. She concluded the Ministry of Health and Ontario Health do not consistently plan, monitor, or evaluate primary care initiatives.

The Health Care Connect (HCC) system, designed to match people with a family doctor, remains unable to meet demand. As of June 2025, 178,000 Ontarians were waiting for referrals. Of these, 108,000 had waited longer than a year, including 5,000 people with complex health needs. The auditor also noted wide variations in referral wait times: between 2020/21 and April 2025, nearly half of patients were matched in under 21 days, while 15% waited more than 260 days.

Twelve family health teams have withdrawn support for HCC, calling the 2009-era tool “no longer fit for purpose.” The province also has not updated its communications plan for the system since 2015, which may explain why only 235,000 Ontarians—about 11% of those without a family doctor—are registered.

Regional Networks Lack Authority to Coordinate Care

Ontario has directed 58 Primary Care Networks to help organize local primary care services, but Spence reported the province has not given them authority to require providers to participate. As a result, many networks lack accurate information on how many physicians practise in their regions. This gap jeopardizes the government’s Primary Care Action Team goal of achieving 100% primary care attachment by 2029.

Earlier this year, the province announced its $1.8-billion Primary Care Action Plan, which aims to connect every resident to primary care within four years. However, Spence noted the plan lacks clear timelines and measurable performance targets. While government MPP Anthony Leardi said waitlists have been “cut in half or more,” Stiles argued the absence of metrics shows the plan “is not a plan at all.”

Medical School Expansion Not Fully Supported by Analysis

The audit also examined Ontario’s plan to expand medical education by adding 340 undergraduate and 551 postgraduate seats by the 2028/29 academic year, with 60% dedicated to family medicine. Spence found the government did not document analysis to justify the number of seats, the proportion allocated to family medicine, or the decision to establish two new medical schools rather than expand existing programs.

Medical schools have rolled out 89 fewer family medicine seats than planned due to shortages in training sites. Spence warned that the province lacks a framework to measure whether the expanded seats will meaningfully improve access to family doctors. Leardi maintained that physician output is still rising, noting a 30% increase in medical school graduates compared to earlier years.

PPE Inventory Management Still Struggling

Spence also reported persistent weaknesses in Ontario’s management of personal protective equipment. Since 2021, the province has written off more than $1.4 billion in PPE due to expiry and mismanagement. Previous audit recommendations from 2022 and 2023 remain only partially implemented.

Supply Ontario, created in 2023 to centralize procurement, still lacks an integrated inventory system that tracks quantities and costs. The auditor said delays in receiving documents and ongoing reliance on manual tracking continue to complicate oversight. A new third-party logistics contract has been signed, but full system integration is still pending.

Recommendations Accepted, but Concerns Remain

The auditor issued 11 recommendations to improve primary care access and oversight. The government accepted all of them. But opposition leaders say the report confirms chronic under-planning across multiple areas of Ontario’s healthcare system.