Ontario Doctors Demand Apology After Ministry Flags High Patient Volumes

The Ontario Medical Association is demanding an apology from the provincial government after it says hundreds of doctors received letters flagging them for working too many days or seeing too many patients in a single day. The association warns the notices could push already stretched physicians to cut hours at a time when Ontarians are struggling to find family doctors.

"The hours that we're working to see patients, the extra hours we're working on evenings and weekends, that's not fraud. That's patient care. That's our job," OMA president Dr. Rebecca Hicks told CBC News. "We should be supporting physicians who are doing that, not sending them warnings of investigations."

Hicks said "at least hundreds" of high-volume billing letters went out across the province, though she did not have an exact count. CBC reported seeing one letter from the Ministry of Health's payment accountability and fraud control unit dated Oct. 27. It said physician billing is monitored "to support the integrity, accountability, and sustainability of the Ontario Health Insurance Plan (OHIP)" and flagged "anomalous behaviour" compared with doctors who have similar practice profiles.

What the letters say — and what the ministry says they mean

According to Hicks, doctors were flagged either for a high number of days worked in a year or for seeing too many patients in a single day. The letter acknowledged that billing patterns can have legitimate explanations, but added that persistent unusual billing may face further ministry review, CBC reported.

Health ministry spokesperson Lily Barnes told CBC the letters are meant to be educational and are not an assumption that billing was "inappropriate." She said doctors can be flagged for abnormal billing if they worked more than 15 hours or saw more than 100 unique patients in a day. "The ministry recognizes that physicians have diverse practice models, specialties, patient populations, and service delivery arrangements that may appropriately result in higher billing volumes," Barnes said in an emailed statement. The ministry did not answer CBC's questions on how many letters went out or what billing level would trigger an investigation.

Health-law firm Rosen Sunshine LLP wrote on Nov. 4 that it has seen Ministry of Health letters labeled "HIGH VOLUME BILLINGS" that do not seek repayment but flag a "high number of days worked in a single year," including for physicians who regularly work close to seven days a week. The letters ask doctors to review their billing practices and warn that unusual patterns may lead to further review, according to its blog post.

Doctors say the timing could hurt patients

Dr. Adam Stewart, who works at a family health organization in Madoc, Ont., told CBC it was unfair to send "a threatening, intimidating letter" during a shortage of family physicians. He said he has about 1,700 patients and typically sees people for more than 30 hours a week, plus 10 to 20 hours of paperwork, and that a colleague with fewer hours and about 1,150 patients also received a letter, CBC reported. Stewart also told CTV News Toronto he wants an apology after being flagged for the high number of days he worked.

Hicks said there is no cap on how many days doctors can work or how many patients they can see in a day, and that the province's new family medicine remuneration model allows up to 14 hours a day through hourly billing. Rural doctors may work longer hours because of local demand, she said. "There's so much demand right now," Hicks told CBC. "If they're being asked to cut back on that, well, where are [patients] supposed to go?"

Auditor general already flagged weak billing oversight

The dispute lands against Auditor General Shelley Spence's 2025 annual report on physician billing. Spence found the ministry's OHIP claims system cannot automatically flag high-risk billings such as doctors claiming more than 24 hours of work in a day, and that the province relies heavily on tips and complaints to trigger post-payment audits, according to the auditor's news release.

An analysis of claims over three years found that in each year at least 59 physicians billed 24 or more hours of services in a single day, rising to 82 physicians in 2024/25, the auditor's performance audit on oversight of physician billing said. The same audit noted the ministry had begun sending education letters to physicians with a high number of hours billed in a day, which may feed future post-payment audits. Hicks said the OMA will seek more information on how the ministry decided who received the latest letters.