Appeal by first doctor ever thrown out of MSP fails

Carvalho has long history of improper claims for medical services not provided

An infamous Vancouver doctor won’t be able to resurrect his medical career after the B.C. Court of Appeal dismissed his bid to overturn permanent de-enrolment in the Medical Services Plan.

Dr. Gustavo Carvalho has a long and checkered history of disciplinary actions by the College of Physicians and Surgeons of B.C. and even a criminal conviction. He was the first — and only — B.C. doctor to have his enrolment in the taxpayer-funded Medical Services Plan permanently cancelled by the Medical Services Commission because of improper claims for medical services not provided.

Carvalho’s lawyer tried to argue before the appeal court that the commission did not have jurisdiction to make the order that Carvalho could never reapply to the plan in his lifetime. Doctors must be enrolled in the plan in order to bill the government for medical services provided to patients. Doctors submit claims to the Medical Services Plan so they can be paid for services provided to patients. There are about 4.8 million patients enrolled in the plan who receive services from about 11,000 doctors submitting more than 90 million claims each year worth about $3 billion.

The appeal court panel said the commission — the government agency that manages the medical insurance plan — was justified because of all the transgressions by Carvalho, including:

Billing for 140 services that weren’t patient benefits and weren’t supported by any medical records.

Billing for a plastic surgery procedure for which no records exist.

Billing for 92 services for which records were incomplete or inadequate.

Maintaining incomplete, inaccurate, inaccessible records that were kept in a different location from the clinics where he worked. Records were either knowingly false or made while being wilfully blind to their accuracy.

Providing no reasonable justification for his actions.

Failure to comply with a college order made in 1999 that he maintain adequate records and that he no longer bill for services that were not necessary.

In a written decision on behalf of the unanimous court, Justice David Harris said “Carvalho had engaged in infamous and repeated instances of serious misconduct and, as a result, had lost the trust of the Medical Services Commission required to maintain the integrity of the MSP.”

The commission was therefore entitled to exercise its discretionary powers and committed no errors in doing so.

As to Carvalho’s argument that his principal problem was merely poor record keeping, the court said:

“Even a cursory review of the findings (shows) Dr. Carvalho was systematically billing the MSP for medically required services he had not in fact rendered.”

Carvalho could not be reached for comment and his lawyer, Gerald Fahey, said he could not speak to a reporter without getting his client’s consent. The college said Tuesday it has not revoked the doctor’s licence, but he has a “conditional discipline class of registration.”

Carvalho is not currently working as a doctor. Yet on its website, the college shows he works as a family doctor at the Mega Fu Medical Clinic in a Richmond Walmart. Postmedia called the clinic and was told by a receptionist that he hasn’t worked there since last summer. The college said all doctors are required to provide a business address to the college if they hold a licence, so it would seem that is why the clinic address is given.

A year ago, when Carvalho lost his case in B.C. Supreme Court, Justice Shelley Fitzpatrick said: “In what can only be described as an understatement, Dr. Carvalho describes his past behaviour as shameful.”

Carvalho was licensed to practice medicine in B.C. in 1990 after graduating from the University of Alberta medical school. In 2003, he was convicted of criminal harassment of a former girlfriend, public mischief and breach of the conditions of his sentence. The provincial court judge called him devious when sentencing him to a year of house arrest and three years’ probation after Carvalho entered a guilty plea. The college suspended him for a year and when he went back to work in 2007 after taking a mental health break, he was issued restrictions on his practice, including being monitored and getting psychiatric treatment.

He withdrew from medicine two years later when the Medical Services Commission took another look at his billing habits and found breaches again. He took another two years off from medicine but then went back in 2011. In 2012, he admitted to submitting a few dozen false claims for patients he never saw or for services he didn’t provide. The college fined him $50,000 and gave him a threemonth suspension.

Then in 2015 he didn’t show up for a commission hearing, explaining that he missed it because of a car accident and an overdose of antianxiety medications.

He was admitted to a hospital psychiatric unit.

The commission’s panel proceeded without him and ordered him to repay $200,000 in overbillings.

Carvalho had engaged in infamous and repeated instances of serious misconduct.