The 53-year-old was granted bail to receive medical treatment despite being found guilty of a plan to defraud the Australian Tax Office with four co-conspirators.
He was due to front the NSW Supreme Court on Friday, when Justice Desmond Fagan was scheduled to hear an application from prosecutors to put him behind bars ahead of sentencing.
"What's the explanation," Justice Fagan asked Alex when he instead appeared via video-link from a Sydney hospital.
"I don't have one, Your Honour," the 53-year-old replied.
George Alex faces incarceration for "a significant amount of time", the court was told. (Nikki Short/AAP PHOTOS)
Alex and the four other men were also found guilty after a marathon trial of either conspiring to or intentionally dealing with proceeds of crime worth more than $1 million.
The group used a number of second-tier "shield" companies to hide more than $10 million of pay-as-you-go tax from the ATO between 2018 and 2020.
While the four other men were taken into custody after the guilty verdicts, Alex's doctor convinced the judge to keep him out on bail to receive opioid treatment in Northern Beaches Hospital, where he has been since August 23.
But after Alex failed to appear, Justice Fagan said he was "left with no alternative" but to issue a warrant for his arrest.
"I think its inevitable he will be incarcerated for a significant amount of time," he said.
Alex's barrister, John Agius SC, said an arrest warrant was not advisable as the labour-hire boss would not receive appropriate treatment for his addiction while in custody.
"The price he will pay for this is the loss of his leg," he said.
Alex picked up an opioid addiction in 2014 when he self-treated a leg injury he picked up 30 years ago, the court heard.
His opioid use peaked at 240mg per day.
As a consequence, Alex was receiving a buprenorphine substitute in hospital on a treatment plan.
But Justice Fagan told Alex's legal team the matter has moved "too far" out of their hands and he would be arrested and brought before the court ahead of his September 21 sentencing date.
He said he didn't accept a health issue could become a sudden crisis after a six-month trial.
Special conditions could not be established after Alex effectively went "on a bender", the judge said.
Alex could be brought before the court later on Friday if he is promptly arrested.
