B.C. doctor's licence permanently cancelled after decades of misconduct and fraudulent billing

A Metro Vancouver family doctor with a long history of discipline for fraudulent billing and misconduct will soon have his medical licence permanently cancelled by his professional college.

Dr. Gustavo Carvalho, who most recently worked in Richmond, B.C., was already banned for life from billing to the Medical Services Plan (MSP). He was the province's first ever physician to be permanently de-enrolled from the public health insurance system.

Now his registration in the College of Physicians and Surgeons of B.C. will be revoked on New Year's Day, with a lifetime ban on re-applying, after he admitted to breaking several conditions placed on his practice because of previous disciplinary issues, according to a notice on the college's website.

The notice says the college's inquiry committee "was concerned that Dr. Carvalho continued to commit unprofessional conduct, including professional misconduct, following decades of regulatory actions taken against him and attempted remediation."

Carvalho has consented to the cancellation of his licence, according to the notice. He has not responded to requests for comment.

Taken together, the college's notice and court records detail three decades' worth of investigations, misconduct and discipline for Carvalho.

His history with the college begins all the way back to 1993, just three years into his medical career, when he was suspended and fined $20,000 for "infamous conduct" for billing MSP for services he never provided.

A judge who rejected Carvalho's appeal of those disciplinary measures noted that "his dishonesty strikes at the root of the system and undermines the integrity of his profession."

Carvalho was reprimanded again in 2001 for failing to protect the confidentiality of patient records by disposing of their files in a recycling bin at his clinic in Vancouver.

His name was then erased from the college's register in 2003 after criminal convictions for harassment and breaching the conditions of his sentence.

Billing MSP for fake appointments

Carvalho returned to work in 2007, and it didn't take long for him to attract the college's attention once more.

In 2012, he was suspended again and fined $50,000 for making improper claims to MSP. According to a college news release from that time, he received about $4,000 in public funds by invoicing for 27 fake appointments with patients in 2009.

He then received another reprimand and fine in 2016 for breaking conditions on his practice, and in 2018, he was suspended and fined one more time for breaching the conditions on his practice related to record-keeping and working under supervision.

Meanwhile, at the same time the college was keeping an eye on Carvalho, B.C.'s Medical Services Commission was watching his billing to MSP.

In 1999, he agreed to pay back $48,404 he'd improperly billed to the public system between 1991 and 1997, according to a 2016 court decision.

The commission audited Carvalho in 2014, and found inappropriate billing in a third of the randomly selected services he'd invoiced for, the decision says. In more than half of those cases, the commission found no medical records to support the invoices.

A panel assembled by the commission decided to cancel Carvalho's MSP enrolment for life, and ordered him to pay $184,138 plus interest for the false billings.

He appealed that decision in B.C. Supreme Court and then in the Court of Appeal, but failed to convince a judge at any level that his ban should be reversed.

"These were not simply minor lapses of judgment or the result of mistakes perhaps arising from a busy practitioner not paying attention to detail. … The admitted false billings were deliberate actions taken by Dr. Carvalho," B.C. Supreme Court Justice Shelley Fitzpatrick wrote in 2017.

The final cancellation of Carvalho's medical licence comes after he breached a number of undertakings and conditions placed on his practice, according to this week's notice from the college.

The conditions that were broken included: that he have no supervisory duties; that he work under an approved supervising physician; that he practise in a group setting with at least two other full-time doctors; that he have his patient volume and hours of clinical practice approved by the college; that he have the college's written approval before changing any particulars of his practice; and that his professional conduct should be "beyond reproach in every respect."

The college's notice says cancelling Carvalho's registration is "necessary to protect the public and to send a clear message of deterrence to the profession."