Eighty-two doctors billed OHIP for more than 24 hours of work in a single day last year. Not a typo. Not a coding glitch. Eighty-two physicians submitted claims which said they worked more hours than actually exist, and the Ministry of Health’s payment system processed every one of them because it can’t flag that automatically.
If you’ve been following these reports you already know the punchline. Auditor General Shelley Spence finds the same kinds of problems year after year, the government says it accepts the recommendations, then very little changes. It is a cycle at this point, and I’m not sure anyone at Queen’s Park even pretends otherwise.
The Acceptance-and-Ignore Cycle
I went through the AG’s 2025 follow-up report which tracks what happened to recommendations from two and five years earlier. Across all 2023 audits, government bodies fully implemented 31 per cent of recommended actions. Another 40 per cent were “in the process” of being implemented, a phrase which can mean almost anything. And 17 per cent showed little or no progress at all.
That 17 per cent is the number that sticks with me. These aren’t fresh recommendations where you could argue ministry needs time to set things up. Two full years have passed, resources have been allocated (or at least promised), and for roughly one in six items the answer is we haven’t gotten around to it.
The thing is, every government ministry formally “accepts” these recommendations when they’re tabled. It’s a ritual. The AG releases findings, a minister stands up and says the government takes these matters seriously, reporters write their stories, the news cycle moves on. Two years later the follow-up shows most of it went nowhere. Then we do it all over again.
Context: Ontario’s Auditor General operates independently of government and reports directly to the legislature. The office audits government spending and programs, then issues recommendations. Government ministries must respond publicly. The AG follows up at two-year and five-year intervals to track implementation.
The Doctor Billing Problem That Won’t Go Away
This one is personal because I remember reading about OHIP billing problems in AG’s 2016 report. Same finding. Same problem. Nine years on and not much has moved.
Here’s what Spence found in 2025. The Ministry of Health paid $19.5 billion to about 35,000 physicians through OHIP in the 2024/25 fiscal year. The billing system which processes these payments can’t automatically flag unusual or high-risk claims. A physician could submit for 26 hours in a day, the system would just process it.
At least 59 doctors billed for more than 24 hours of service in a single day in each of the last three years, with a high of 82 in 2024/25. Over 100 doctors in each of those years submitted claims for working all 365 or 366 days. Every single day. No weekends, no holidays, no sick days.
And how many people does ministry have auditing these billings?
Eight. Same number as 2016.
The ministry’s own analysis estimated that 3 to 5 per cent of fee-for-service claims had potential anomalies. On $13.3 billion in fee-for-service payments that works out to somewhere between $400 million and $665 million in claims which need a closer look. The ministry recovered $8.1 million between 2022 and 2025. I don’t need to explain the gap.
OHIP Billing: Flagged vs Recovered
Ontario Place: $2.2 Billion and a Process the AG Called Unfair
The Ontario Place file landed on AG’s desk twice, once in 2024 and again in 2025. Neither report was kind.
Spence’s 2024 audit found the process which awarded a 95-year lease to Austria’s Therme Group was “not fair, transparent or accountable.” The government didn’t follow its own procurement rules. An Infrastructure Ontario VP who was supposed to be assessing bids exchanged emails and a phone call with Therme’s legal counsel. Three bidders attended meetings with the premier’s office even though the rules specifically banned that, one of those three was Therme.
The cost ballooned by $1.8 billion from initial estimates. As of February 2024 Infrastructure Ontario pegged total redevelopment costs at $2.2 billion.
For a waterpark and spa.
Look, I’ll give the government credit for wanting to do something with Ontario Place. It’s been underused for years and sitting on a prime lakefront site. But the AG’s findings aren’t about whether a waterpark is a good idea (debatable), they’re about whether the process for spending $2.2 billion of public money was legitimate. According to the province’s own auditor, it was not.
Environmental Rights Quietly Stripped Away
The 2025 Environmental Bill of Rights report is where things get genuinely alarming. The AG found the Ford government is “eroding Ontarians’ EBR rights” through a mix of legislative exemptions and flat non-compliance with its own laws.
Two of the province’s biggest infrastructure projects, Highway 413 and Ontario Place redevelopment, were exempted from EBR public consultation entirely. For Highway 413 a 2021 federal assessment raised concerns about species at risk, wildlife corridors, and river systems. When the province sought public feedback on exempting the project from environmental review, the Environment Ministry didn’t mention any of those impacts in consultation notice.
That is not an oversight. You don’t accidentally leave out the fact that your highway runs through habitats for species at risk. You leave it out because including it would generate opposition, and if your case was strong enough you’d want the public process because you’d point to it and say we did the work.
The AG also noted that the Ministry of the Environment failed to educate Ontarians about their EBR rights. Which is literally one of its legal duties. A requirement which exists on paper and nowhere else.
Why Nothing Changes
I’ve read enough of these reports to see the pattern clearly. The AG identifies a problem, it makes news for a day or two, the ministry accepts recommendations, the follow-up shows a third were done and the rest abandoned. Then everyone moves on because there’s no enforcement mechanism.
The AG’s office has no power to compel action. It can report. It can follow up. It can publish follow-up reports showing nothing happened. That’s it. The legislature’s public accounts committee can hold hearings and ask pointed questions, ministers give vague answers about ongoing efforts and priorities, and then we’re done until next year.
Two million Ontarians don’t have a family doctor. The OHIP billing system hasn’t been updated since 2016. Same eight auditors are reviewing $19.5 billion in payments. Ontario Place is costing $2.2 billion through a process the AG called unfair. Environmental consultation rights are being stripped out one exemption at a time.
All of it is in the Auditor General’s reports. All of it has been formally accepted by government.
Almost none of it is being fixed. Shelley Spence will table another report next December and less people will pay attention than this year, which is saying something because not many paid attention this year either.
Sources and verification: OHIP billing findings ($19.5 billion in payments, 82 doctors billing 24+ hours/day, eight auditors, $400-665 million in estimated anomalies) are from the AG’s 2025 Annual Report on Oversight of Physician Billing, reported by CBC News, the Globe and Mail, CP24, and TVO. Recommendation implementation rates (31% fully implemented, 17% little/no progress) are from the AG’s 2025 follow-up report on 2023 audit recommendations. Ontario Place findings ($2.2 billion cost, “not fair, transparent or accountable” process, Therme communications) are from the AG’s 2024 special report, reported by CBC News, Global News, and the Globe and Mail. EBR findings (Highway 413 and Ontario Place exemptions, “eroding Ontarians’ EBR rights”) are from the AG’s 2025 Environmental Bill of Rights report, reported by Canada’s National Observer and The Pointer. The two million Ontarians without primary care is from the AG’s 2025 audit on primary care access. Shelley Spence became Auditor General in January 2024. OHIP billing audit history (2016 comparison) is from the AG’s published archives at auditor.on.ca.
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