Ontario’s Auditor General Report slams healthcare, recycling and how doctors are paid

Ontario’s Auditor General has released her 2025 Annual Report.

“These reports focus on government operations that affect the lives of Ontarians,” said Auditor General of Ontario Shelley Spence. “Access and availability of a family physician, how they are paid, keeping waste out of landfill, or spending on PPE are government services that are worth examining.”

Oversight of access to primary care

The Auditor General says efforts to fix access to primary care are fragmented and overdue as millions of Ontarians still struggle to find a family doctor.

The audit found the Ministry of Health and Ontario Health didn’t have consistent processes in place to improve access to primary care providers.

The province’s centralized matching program Health Care Connect, has not met demand as more than 108,000 Ontarians have been waiting over a year to be matched with a doctor.

As of January 2025, The number of Ontarians on the wait list represented only 11 per cent of the estimated number of Ontarians needing a family doctor.

The audit found that Ontario Health Teams and local primary care networks lack the authority to require local providers to collaborate on system planning.

Failure to co-ordinate physician recruitment at the provincial level has resulted in a fragmented and competitive approach to recruitment across the province.

Oversight of medical education in family medicine

The province expanded medical school seats without making sure there were enough training sites or a clear framework to measure outcomes.

The audit found that the Ministries of Health, and Colleges, Universities, Research Excellence and Security did not analyze how many seats were needed or whether schools had capacity.

Two new medical schools were approved without assessing whether existing schools could have been expanded instead.

The audit found that by the end of the 2025/26 academic year, medical schools had rolled out 44 per cent fewer family medicine seats than planned due to a lack of training clinics.

INSPIRE-Primary Health Care and the Ministry of Health indicated that about 2 million Ontarians were not attached to primary care in 2024, which is a higher estimate than what the ministry had used in its forecast model to support the medical seat expansion.

Based on the AG’s analysis, about 2,000 family physicians would be necessary to meet this need in 2024.

Oversight of physician billing

The Ministry of Health lacks a modernized payment system and isn’t using data analysis to detect potentially inappropriate physician billings.

The Ministry paid $19.5 billion to about 35,000 physicians in 2024/25 and relies on tips and complaints to trigger post-payment audits.

The Ontario Health Insurance Plan (OHIP) system cannot automatically flag unusual or high-risk billings, such as physicians claiming over 24 hours of work in a day.

A system modernization initiative announced in 2023 has been delayed, awaiting approval by the government.

Eight staff currently conduct post-payment audits. Post-payment audits could take more than a year to complete.

The Ministry noted that 3-5 per cent of fee-for-service (FFS) claims reviewed had potential anomalies in 2024.

Based on the $13.3-billion in FFS payments in 2024/25, this translated to approximately $400 to $665-million in payments that would require additional review.

Supply Ontario: Management of personal protective equipment

Supply Ontario lacks an integrated inventory management system. The audit found that hospitals and other clients are not utilizing the stockpile.

Hospitals received only 2-3 per cent of distributed PPE. Many clients reported unclear program objectives, quality concerns and limited communication from Supply Ontario.

Over 1-billion PPE items, valued at about $1.4-billion, were written off between 2021/22 and 2024/25. More stock is projected to expire in the coming years.

Supply Ontario does not track full order-to-delivery times and doesn’t have an integrated inventory system, limiting its ability to plan, monitor performance, and respond to demand.

Resource Productivity and Recovery Authority (RPRA)

RPRA could do more to ensure that Ontario’s recycling framework is working as intended.

This includes reducing its backlog of potentially unregistered producers, enforcement against non-compliant producers, and require the auditing of producers’ data for its programs.

The Resource Recovery and Circular Economy Act, 2016 requires producers of landfill waste, such as tires, batteries, lighting, electronic e-waste and hazardous materials to collect and recycle or reuse it after consumers have disposed of them.

The Auditor General found that RPRA rarely escalated enforcement against producers that failed to report their supply and waste recovery data as required.

RPRA has issued compliance orders to only 4 per cent of such violators, most of which remain unresolved. They also failed to finalize audit procedures for producers of most programs, increasing the risk of inaccurate resource recovery data being reported.

RPRA did not have formal processes to proactively analyze and bring forward systemic compliance challenges to the Ministry of the Environment, Conservation and Parks (MECP) to resolve them.

The audit also found that MECP made regulatory changes without addressing RPRA’s concerns or providing RPRA time to make operational updates.

Operation of the Environmental Bill of Rights, 1993 (EBR)

The province continues to disregard Ontarians’ public participation rights by exempting major projects and passing laws without full public consultation under the EBR.

During the audit, the province passed Bill 17, the Protect Ontario by Building Faster and Smarter Act, before consultation under the EBR was complete and without consulting at all on an amendment to the Building Code Act intended to end the practice of municipalities enforcing their own green building standards.

The province also exempted approvals for two major projects, Highway 413 and the Ontario Place redevelopment, from EBR consultation altogether.

The report concludes that government actions are eroding public participation rights and transparency in environmental decision-making.

“When decisions that could significantly affect Ontario’s environment are made without meaningful public consultation, it reduces government accountability, and can undermine the public’s confidence in government decision-making about environmental matters.” said The Commissioner of the Environment, Dr. Tyler Schulz.

The full report can be found here.