Richmond’s 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 of 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 Ministry of Health.
(A few other doctors voluntarily dropped out after damning audits.)
Without a Medical Services Plan billing number, Carvalho can still bill patients directly, but only for services not covered by the government health insurance, such as cosmetic procedures, like wart removal. 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.
She couldn’t say if he might lose his licence to practise in B.C. “Each investigation is conducted based on the unique circumstances of the case,” she said.
The college has disciplined and suspended Carvalho three times.
In June of 2012, the Richmond News reported that Carvalho had been suspended for three months after admitting to creating false appointments for patients and collecting payments from the subsequent invoices. At the time, Carvalho received payment of nearly $4,000 from the Medical Services Commission for the imaginary services and consented to a host of penalties, including a $50,000 fine and reimbursement to the MSC. Carvalho was also ordered to undergo counselling, practise under a supervisor and see patients only when other clinic staff are present.
In 2002, he was convicted of criminal harassment of a former girlfriend, public mischief and breach of the conditions of his sentence. Provincial court Judge C.J. Bruce called him devious and sentenced him to a year of house arrest and three years’ probation after he pleaded guilty to the charges. He also noted that Carvalho appeared to have “severe personality disorders” along with anti-social conduct. 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 the service was 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 that Carvalho submitted for payment, a third were improper because there was either no record of him seeing patients for the services he billed or 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” since he has lost his billing number.
In 2014-15, Carvalho received gross payments of $280,500 from the MSP.
“You can see from the decision that Dr. Carvalho is far from perfect. But what does not appear in the decision, unfortunately, is the personal side of this case,” Fahey said in an interview, referring to mental health problems with which Carvalho has struggled for years.
He said the panel went ahead with its hearing “despite knowing that the subject (Carvalho) had been involuntarily committed to a psychiatric facility for a 48-hour observation period.”
According to the panel’s decision, Carvalho was given a year’s notice of the two-week hearing date. But he didn’t get a lawyer until after the hearing began and the reasons he gave for not showing up included that he had heart problems, drug impairment (from overuse of anti-anxiety drugs) and a minor car accident.
Last fall, Fahey unsuccessfully sought an adjournment and a reopening of the hearing on the grounds of procedural unfairness.
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 been confidential. [email protected] Twitter:@MedicineMatters
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