Ontario's auditor general says the installation of hydro Smart Meters in 4.8 million homes and businesses across the province is costing ratepayers nearly double what the government originally budgeted.

It's one of the highlights in auditor general Bonnie Lysyk's annual report, tabled in the legislature Tuesday afternoon.

Other key criticisms of government spending:

The Health Ministry does not know what happened to around one million doses of the flu vaccine purchased each year for the past three years.

The auditor found "serious deficiencies" in the province's immigration program that she said could allow unqualified people to get permanent residency.

The government is wasting money by keeping terminally ill patients in acute care hospital beds instead of more appropriate palliative care.

The auditor reveals it cost $1.9 billion to install Smart Meters across the province. The government originally told the public the cost would be closer to $1 billion.

Smart Meter analysis was flawed

The auditor found the Energy Ministry did not do a cost-benefit analysis before cabinet approved the Smart Meter program. A business case was done after the roll-out began, but Lysyk says the analysis was flawed.

"Its projected net benefit of $600 million was overstated by at least $512 million," said Lysyk. "The Ministry has neither updated the projected costs and benefits nor tracked the actual costs to determine the actual net benefits."

Lysyk says Smart Meters are not reducing demand for electricity at peak times, although that was the key reason for launching the program.

The province's child-care licensing program also comes in for criticism.

The auditor says Ontario's background checks on daycare staff are not stringent enough. Licensed daycare centres are only required to do criminal record checks. She recommends what are called "vulnerable sector checks" which also screen people for contact with police short of convictions.

Child-care background checks raise red flags

Her investigation of a sample of new daycare centres found that only half had even basic criminal record checks on file. And she found the Education Ministry failed to inspect one-third of daycare centres during their licensing —period including some flagged as high risk for safety concerns.

"The Ministry's inspection processes and enforcement actions need to be improved to ensure children are safe," said Lysyk.

The auditor general is also sharply critical of the government's immunization program.

The Health Ministry does not know what happened to 961,000 doses of the flu vaccine purchased in 2013 and 2014. That's about 20 per cent of the doses distributed annually. The flu immunization program costs about $25 million annually.

The auditor's investigation also found 20,900 cases where doctors or pharmacists double billed for giving the flu shot more than once to the same person. She even found one case of a doctor who billed OHIP 18 times for giving the flu shot to the same patient.

"There are no controls to prevent payments if a claim is made for multiple immunizations of the same person," write Lysyk.

And the auditor says a new computer system for keeping track of vaccinations is costing taxpayers $160 million; that's more than double its original budget of $75 million.