Medical Services Commission strikes doctor permanently

Audit found Richmond physician faked patient appointments, made billing errors

VANCOUVER — Dr. Gustavo Jose Carvalho has been in trouble with legal and regulatory authorities for serious improprieties almost from the time he was licensed to practise medicine in B.C. in 1990.

Now, after an audit found fake patient appointments and billing errors amounting to about $200,000, he has the distinction of being the first doctor in B.C. permanently struck from the Medical Services Commission against his will, according to the B.C. Ministry of Health. (A few other doctors voluntarily dropped out after damning audits.)

Carvalho, who got his medical degree in 1988 from the University of Alberta, has worked at a Richmond walk-in clinic in the Ackroyd Medical Centre since 1990. It is unclear where, or if, he will work now.

Susan Prins, spokeswoman for the College of Physicians and Surgeons, said it recently learned of the commission’s decision. The college, which licenses doctors, is now required to conduct its own investigation which could lead to disciplinary action.

The college has disciplined and suspended Carvalho three times, most recently in 2012, when he was fined $50,000 and temporarily suspended for “fraudulently” invoicing MSP for services never rendered or not documented.

In 2002, he was convicted of criminal harassment of a former girlfriend, public mischief and breaching the conditions of his sentence.

The college temporarily stripped him of his licence to practise medicine after the conviction.

The Medical Services Commission, which manages B.C.’s public health insurance plan, has audited him twice, finding numerous billing errors. Doctors are supposed to record the location where a service has been provided, the time spent with the patient and the diagnosis. Carvalho has been ordered to repay the taxpayer-funded health insurance plan $184,138 plus interest and surcharges.

Carvalho said in a letter to the panel that he kept some records at his home. They were handwritten notes that contained little information.

The practice of making supplementary notes and keeping them at home “calls into question the bona fides” of the records, raising the question of whether they were created after the audit, according to the commission’s decision.

The latest audit showed that of about 800 randomly chosen claims Carvalho submitted for payment, a third were improper. Sometimes there was no record of his seeing patients for the services for which he billed. Many bills were wrongly coded and too high.

Carvalho’s permanent delisting from the Medical Services Plan is the maximum penalty “reserved for the most exceptional, egregious cases of individuals motivated by greed using a deliberate plan to defraud,” the commission said in its recent judgment.

Gerald Fahey, the lawyer retained by Carvalho to appeal the delisting to the B.C. Supreme Court, said in an interview that while Carvalho still has a licence to practise, the panel’s “disappointing and extreme” decision has “effectively ended his career as a general practitioner” given that he has lost his billing number.

In his notice of appeal filed this week, Fahey contends, among other things, that the panel violated Carvalho’s constitutional rights by admitting into evidence disciplinary documents from the college that he maintains should have remained confidential.