A family physician based in Madoc says Ontario’s Ministry of Health recently flagged him for billing too many hours in a single year.
Dr. Adam Stewart works out of the Tri-Area Medical Centre as part of the Central Hastings Family Health Team.
“Imagine me, an Ontario family doctor, opening a letter like this from the Ministry this morning, that is flagging me and basically threatening me for working too many days in a single year. You really can’t make this stuff up,” Dr. Stewart said in a video posted to social media on Tuesday.
The letter shown in the video comes from the Payment Accountability and Fraud Control Unit, warning that further review may follow if unusual billing patterns persist.
“It doesn’t specify an incorrect claim. It doesn’t tell me which year they examined, how many days they counted, or what threshold I crossed,” Dr. Stewart explained.
Dr. Stewart described the letter as “threatening.”
“Consider how this letter lands with a conscientious family doctor already working flat out. It can make doctors anxious about continuing the very work their patients need,” Dr. Stewart said in the video.
“This letter is intimidating, and it risks discouraging the additional care Ontario is asking us to provide.”
In a statement to Quinte News, spokesperson for the Minister of Health Lily Barnes said the Ministry is in regular communication with physicians about OHIP billing practices.
“This specific outreach was about abnormal billing patterns, meaning a physician had higher-than-expected billing based on claims data, and reviewing their billing practices and ensure compliance,” Barnes said in the statement.
“To be clear, the outreach is educational and does not assume the billing was inappropriate.”
Abnormal billing can include more than 15 hours of billed services in a single day, and more than 100 unique patients billed in a single 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.
“To ensure physicians can spend more time with their patients, our government has introduced a number of changes through the Patients Before Paperwork initiative that are saving physicians over 95,000 hours. This includes the innovative primary care team (FHO+) model. We continue to work with the OMA to modernize the billing system to make it even more efficient.”
Last year, Ontario’s Auditor General Shelley Spence released a report saying that the Ministry of Health lacked effective systems to oversee and prevent inappropriate OHIP physician billings, which totalled $19.5 billion in 2024-25.
You can find a link to the full report here.
